# Patent

## Title
Devices, systems and methods for improving memory and/or cognitive function through brain delivery of siRNA

## Abstract

The present invention relates to devices, systems, and methods for improving memory and/or cognitive function by brain delivery of compositions of small interfering RNA or vectors containing the DNA encoding for small interfering RNA. Such compositions can be administered using devices, systems and methods for direct delivery of the compositions to the brain, or using devices, systems, methods of delivery, and compositions that deliver small interfering RNA or vectors containing the DNA encoding the small interfering RNA across the blood-brain barrier. The present invention also provides valuable small interfering RNA vectors, and methods for reduction of BACE1 levels in the hippocampus, cerebral cortex, or other regions of the brain that have beneficial effects on improving memory and/or cognitive function in a subject.

## Background
CROSS REFERENCE TO RELATED APPLICATIONS
This application is a Continuation of U.S. patent application Ser. No. 11/930,939, filed Oct. 31, 2007 and now U.S. Pat. No. 8,058,251, which is a Continuation-in-part of application Ser. No. 11/253,393 filed on Oct. 19, 2005 and now U.S. Pat. No. 7,618,948, which is a continuation-in-part of U.S. application Ser. No. 10/852,997, filed on May 25, 2004 and now U.S. Pat. No. 7,829,694, which is a continuation-in-part of U.S. application Ser. No. 10/721,693, filed on Nov. 25, 2003 and now U.S. Pat. No. 7,605,249, which claims priority from U.S. Provisional Patent Application No. 60/444,614, filed on Feb. 3, 2003, and U.S. Provisional Patent Application No. 60/429,387, filed on Nov. 26, 2002, which are incorporated herein by reference. U.S. application Ser. No. 11/253,393 is also a continuation-in-part of U.S. application Ser. No. 11/157,608, filed on Jun. 21, 2005, and PCT Patent Application No. US05/022156, also filed on Jun. 21, 2005 which claim the benefit of U.S. Provisional Application Ser. No. 60/581,730, filed Jun. 21, 2004, and which are also incorporated herein by reference.


FIELD OF INVENTION
This invention relates to devices, systems, and methods for improving memory and/or cognitive function by brain delivery of small interfering RNA or vectors containing the DNA encoding for small interfering RNA.
BACKGROUND OF THE INVENTION
Memory, or the function of a living organism to store information and retrieve it at a later time in a functional form, comprises multiple processes and requires the function of many different brain areas. Human memory provides declarative recall, i.e., facts and events accessible to conscious recollection, and non-declarative recall, i.e., procedural memory of skills and operations not stored regarding time and place.
The processing of information to be added to memory occurs in several stages. A newly acquired experience initially is susceptible to various forms of disruption. With time, however, the new experience becomes resistant to disruption. This observation has been interpreted to indicate that a labile, working, short-term memory is “consolidated” into a more stable, long term memory. The initial phase of memory consolidation occurs in the first few minutes after we are exposed to a new idea or learning experience. The next phase occurs over a longer period of time, such as during sleep. If a learning experience has on-going meaning to us, the next week or so serves as a further period of memory consolidation. In effect, in this phase, the memory moves from short-term to long-term storage.
Various mechanisms have been proposed for the formation of long-term memory. A wide range of observations suggest an evolutionarily conserved molecular mechanism for the formation of long-term memory. These observations include increase in release of synaptic transmitter and number of synaptic receptors as well as decrease in Km of the receptors, synthesis of new memory factors either in the pre-synaptic or post-synaptic element, new synaptic connections, and increase in the active area in the pre-synaptic membrane. Synaptic plasticity, the change in the strength of neuronal connections in the brain, is thought to underlie long-term memory storage.
On the molecular level, a series of classic studies showed that inhibition of mRNA and protein synthesis during a critical time window could disrupt the formation of long-term memory. Initial learning and recall of previously stored information was not impaired by the transient blockage of protein synthesis. This led to a hypothesis that new gene expression is necessary for the conversion or consolidation of a short-term modification of the brain into a long-term memory.
Memory consolidation, or long-term memory, is also believed to play a crucial role in a variety of neurological and mental disorders, including mental retardation, Alzheimer's disease and depression. Indeed, loss or impairment of long-term memory is a significant feature of such diseases.
For several neurodegenerative diseases, such as Parkinson's disease, Alzheimer's disease, Huntington's disease, Spinocerebellar Ataxia Type 1, Type 2, and Type 3, and dentatorubral pallidoluysian atrophy (DRLPA), proteins involved in the overall pathogenic progression of the disease have been identified. There is currently no cure for these neurodegenerative diseases. These diseases are progressively debilitating and most are ultimately fatal.
Further problematic of these neurodegenerative diseases (especially Alzheimer's disease and Parkinson's disease) is that their prevalence continues to increase, thus creating a serious public health problem. Recent studies have pointed to alpha-synuclein (Parkinson's disease), beta-amyloid-cleaving enzyme 1 (BACE1 (including variants thereof, e.g. variants A, B, C, and D)) (Alzheimer's disease), huntingtin (Huntington's disease), and ataxin 1 (Spinocerebellar Ataxia Type 1) as major factors in the pathogenesis of each of these diseases, respectively.
The neurodegenerative process in Parkinson's disease and Alzheimer's disease is characterized by extensive loss of selected neuronal cell populations accompanied by synaptic injury and astrogliosis. Pathological hallmarks of Alzheimer's disease include formation of amyloid plaques, neurofibrillary tangles and neuropil thread formation. Although the mechanisms triggering cell dysfunction and death are unclear, the prevailing view is that neurodegeneration results from toxic effects subsequent to the accumulation of specific neuronal cell proteins, such as amyloid precursor protein (APP) (Alzheimer's disease—processed into beta-amyloid by BACE1 (including variants thereof, e.g. variants A, B, C, and D)).
Alzheimer's disease is a progressive degenerative disorder of the brain characterized by mental deterioration, memory loss, confusion, and disorientation. Among the cellular mechanisms contributing to this pathology are two types of fibrillar protein deposits in the brain: intracellular neurofibrillary tangles composed of polymerized tau protein, and abundant extracellular fibrils comprised largely of beta-amyloid. Beta-amyloid, also known as Abeta, arises from the proteolytic processing of the amyloid precursor protein (APP) at the beta- and gamma-secretase cleavage sites giving rise to the cellular toxicity and amyloid-forming capacity of the two major forms of Abeta (Abeta40 and Abeta42). Thus, preventing APP processing into plaque-producing forms of amyloid may critically influence the formation and progression of the disease making BACE1 (including variants thereof, e.g. variants A, B, C, and D) a clinical target for inhibiting or arresting this disease. Similar reports suggest presenilins are candidate targets for redirecting aberrant processing.
The design and use of small interfering RNA complementary to mRNA targets that produce particular proteins is a recent tool employed by molecular biologists to prevent translation of specific mRNAs. Various groups have been recently studying the effectiveness of siRNAs as biologically active agents for suppressing the expression of specific proteins involved in neurological disorders. Caplen, et al. (Human Molecular Genetics, 11(2): 175-184 (2002)) assessed a variety of different double stranded RNAs for their ability to inhibit cell expression of mRNA transcripts of the human androgen receptor gene containing different CAG repeats. Their work found gene-specific inhibition occurred with double stranded RNAs containing CAG repeats only when flanking sequences to the CAG repeats were present in the double stranded RNAs. They were also able to show that constructed double stranded RNAs were able to rescue caspase-3 activation induced by expression of a protein with an expanded polyglutamine region. Xia, Mao, et al. (Nature Biotechnology, 20: 1006-1010 (2002)) demonstrated the inhibition of polyglutamine (CAG) expression in engineered neural PC12 clonal cell lines that express a fused polyglutamine-fluorescent protein using constructed recombinant adenovirus expressing siRNAs targeting the mRNA encoding green fluorescent protein.
Other tools used by molecular biologists to interfere with protein expression prior to translation involve cleavage of the mRNA sequences using ribozymes against therapeutic targets for Alzheimer's disease (see WO01/16312A2) and Parkinson's disease (see WO99/50300A1 and WO01/60794A2). However, none of the above aforementioned patents disclose methods for the specifically localized delivery of small interfering RNA vectors to targeted cells of the brain in a manner capable of local treatment of neurodegenerative diseases. The above patents do not disclose use of delivery devices or any method of delivery or infusion of small interfering RNA vectors to the brain. For example, the above patents do not disclose or suggest a method of delivery or infusion of small interfering RNA vectors to the brain by an intracranial delivery device.
The delivery of biologically active agents to the brain is an important and challenging aspect of treating a variety of neurological disorders. For treatment of some neurological disorders, it is desirable to deliver a biologically active agent (e.g., a therapeutic agent) to the brain that will cause brain cells to express DNA, for example, a missing gene (i.e., gene therapy), and/or RNA, for example, a small interfering RNA (siRNA).
Some approaches to gene therapy for neurological disorders involve surgical delivery of non-viral or viral vectors directly into the brain tissue, which is generally necessary since non-viral and viral vectors normally do not cross the blood-brain barrier (BBB). These approaches are limited by difficulty in achieving sufficient distribution and diffusion of the vector into the targeted areas of the brain, and by the potential for viral vectors to produce an immune reaction in the patient. One approach for achieving enhanced diffusion of vectors into the brain tissue is to use the technique of “convection enhanced delivery,” whereby the non-viral or viral vectors are administered at a low flow rate over a long period of time with a pump providing pressure and flow volume to enhance the distribution of the vector into the tissue. While convection enhanced delivery has been shown to yield delivery of molecules and virus particles to substantial three-dimensional regions of rodent and primate brains, scale-up of this delivery approach to the three-dimensional volume of the human brain remains a technical challenge. Effective treatment of certain neurological diseases (e.g., Alzheimer's disease) using a gene or protein delivery or suppression therapy will most likely require delivery of the biologically active agents to most of the human cerebrum. In other neurological disorders, such as Parkinson's disease and Huntington's disease, even though there are circumscribed regions of the brain anatomy that are especially affected by the disease process, for example, the substantia nigra or striatum (caudate and putamen) and result in cardinal symptoms of the diseases (e.g., dyskinesias, rigidity, etc.), patients will likely benefit further from treatment of broader regions of the brain, in which the disease process causes additional symptoms (e.g., depression and cognitive deficits).
An approach of using viral vectors to deliver genes or gene suppressing agents to the brain tissue using stereotactic neurosurgery including, for example, the use of adeno-associated virus (AAV) to deliver gene therapy to the subthalamic nucleus, has shown considerable promise. However, the usefulness of stereotactic neurosurgery to deliver a viral vector carrying a gene or protein suppression therapy can be limited by one or more of the following factors. Stereotactic neurosurgery always involves a low level of surgical risk including, for example, accidental perforation of a blood vessel, which can result in cerebral hemorrhage and death. Dispersion of a viral vector to large regions of brain tissue, even using convection enhanced delivery and optimal vectors, catheter designs, and surgical technique, is likely to be limited relative to what can be attained using the blood stream as the distribution system. Manufacturing of viral particles (e.g., capsid plus DNA payload) in sufficient quantities for therapeutic use, while feasible, is costly relative to production of DNA alone. Viral particles (i.e., the capsid proteins) might be immunogenic, causing adverse reactions in sensitized individuals. While the immune response to some viruses (e.g., AAV) when administered to the brain appears minimal, it remains a potential limitation particularly for repeated therapy administrations.
It would be advantageous to administer a biologically active agent by a route that is no more invasive than a simple intravenous injection. With this approach, a biologically active agent could be delivered through the BBB by targeting the biologically active agent to the brain via endogenous BBB transport systems. Expression of a DNA or RNA in the brain requires that the biologically active agent that is injected into the blood is transported not only across the BBB by, for example, receptor-mediated transcytosis (RMT), but also across the brain cell membrane (BCM) by, for example, receptor-mediated endocytosis (RME) into the target cell in the brain. In addition, using endogenous BBB transport systems to target biologically active agents non-invasively to the brain also requires the development of a suitable formulation of the biologically active agent that is stable in the bloodstream.
An effective method for delivering gene therapy to the entire primate brain using compositions that carry plasmid DNA or antisense RNA across the blood brain barrier and into brain cells was recently disclosed in U.S. Pat. No. 6,372,250 (Pardridge). The reported ability of this method to deliver plasmid DNA to the entire primate brain constitutes an impressive technical breakthrough. However, therapeutic use of the disclosed method may be limited by one or more of the factors listed herein below. Gene expression from a plasmid or RNA is generally temporary (e.g., limited to a period of days or weeks). Intravenous delivery of the disclosed compositions can result in unintended treatment of all bodily organs, potentially resulting in adverse side-effects. Finally, intravenous delivery can result in a loss of dosing as the dose intended for the brain is delivered to other parts of the body.
Further, the foregoing prior art does not disclose any technique for delivering or infusing into the brain small interfering RNA vectors which are then capable of reducing production of at least one protein involved in the loss of memory.
The prior art describes direct systemic delivery of ribozymes. This approach for treatment of memory loss or neurodegenerative disorders would appear neither possible nor desirable. First, interfering RNAs are distinctly different than ribozymes. Second, small RNA molecules delivered systemically will not persist in vivo long enough to reach the desired target, nor are they likely to cross the blood-brain barrier. Further, the approach taken by the prior art may be impractical because of the large quantity of small interfering RNA that might have to be administered by this method to achieve an effective quantity in the brain. Even when the blood-brain barrier is temporarily opened, the vast majority of oligonucleotide delivered via the bloodstream may be lost to other organ systems in the body, especially the liver.
U.S. Pat. Nos. 5,735,814 and 6,042,579 disclose the use of drug infusion for the treatment of Huntington's disease, but the drugs specifically identified in these patents pertain to agents capable of altering the level of excitation of neurons, and do not specifically identify agents intended to enter the cell and alter protein production within cells.
Thus, new compositions and methods for delivering to the brain biologically active agents for the treatment of memory loss and cognitive dysfunction are needed.
SUMMARY OF THE INVENTION
The present invention provides devices, systems, and methods for improving memory and/or cognitive function in a normal brain, or a brain affected by a neurodegenerative disorder, by brain delivery or infusion of small interfering RNA or vectors containing the DNA encoding for small interfering RNA.
A first objective of the described therapies of the present invention is to deliver specifically tailored small interfering RNA as therapeutic agents for enhancement of cognitive function and/or memory function of a subject. In certain embodiments, the subject method can be used to treat patients who have been diagnosed as having or being at risk of developing disorders in which diminished declarative memory is a symptom, e.g., as opposed to procedural memory. As a result, the methods of the present invention may be useful for preventing memory impairment. Contemplated causes of memory impairment include toxicant exposure, brain injury, age-associated memory impairment, mild cognitive impairment, epilepsy, mental retardation in children, and dementia resulting from a disease, such as in certain cases of Parkinson's disease, Alzheimer's disease, AIDS, head trauma, Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, post cardiac surgery, Downs Syndrome, Anterior Communicating Artery Syndrome, and other symptoms of stroke. In addition, the present invention may be useful in enhancing memory in normal individuals.
A second objective of the described therapies is to deliver specifically tailored small interfering RNA as therapeutic agents for treatment of Alzheimer's disease. Specifically tailored small interfering RNA for Alzheimer's disease target the mRNA for BACE1 (including variants thereof, e.g. variants A, B, C, and D) in order to reduce the amount of BACE1 (including variants thereof, e.g. variants A, B, C, and D) protein produced in neurological cells and thereby interfere with the production of beta-amyloid. In a related embodiment the present invention provides devices that specifically access the nucleus basalis of Meynart and the cerebral cortex for delivery of anti-BACE1 (including variants thereof, e.g. variants A, B, C, and D) small interfering RNA.
The present invention provides a method of treating memory loss in a subject caused by the presence of beta amyloid produced from amyloid precursor protein by beta amyloid cleaving enzyme type 1, or BACE1 in the brain.
The present invention also provides a delivery system for a small interfering RNA vector therapy for memory loss or cognitive dysfunction that permits targeted delivery of small interfering RNA or vectors containing DNA encoding for small interfering RNA (small interfering RNA vectors) to targeted sites in the brain for brief durations of time or over an extended period of care for the patient.
In one embodiment of the present invention, small interfering RNA vectors are infused into targeted sites of the brain wherein the small interfering RNA vectors are taken up by neurons and transported to the nucleus of targeted cells. The small interfering RNA vectors are then transcribed into RNA by the host cellular machinery to produce small interfering RNA that prevent production of the targeted protein involved in memory loss or cognitive dysfunction.
In one aspect, the present invention provides a medical system for delivering DNA encoding a biologically active agent across a blood-brain barrier.
In another aspect, the present invention provides methods of using neurosurgical devices to deliver therapeutic small interfering RNA vectors to selected regions of the brain. In particular, the present invention provides methods that use surgically implanted catheters for singular, repeated, or chronic delivery of small interfering RNA vectors to the brain. The small interfering RNA vectors introduced into the affected cells have the necessary DNA sequences for transcription of the required small interfering RNA by the cells, including a promoter sequence, the small interfering RNA sequence, and optionally flanking regions allowing defined ends of the therapeutic small interfering RNA to be produced, and optionally a polyadenylation signal sequence.
In one embodiment, the system includes: a neurovascular catheter having a distal end positioned in a blood vessel supplying a patient's brain; and a means for delivering to the catheter a composition including: an artificial adeno-associated virus (AAV) vector including DNA encoding a biologically active agent; and a component to deliver at least the DNA across the blood-brain barrier.
In another embodiment, the medical system includes a neurovascular catheter having a distal end positioned in a blood vessel supplying a patient's brain; and a means for delivering to the catheter a composition including a receptor-specific nanocontainer, wherein the receptor-specific nanocontainer includes: a nanoparticle or liposome having an exterior surface and an internal compartment; an artificial adeno-associated virus (AAV) vector located within the internal compartment of the liposome, wherein the AAV vector includes DNA encoding a biologically active agent; one or more blood-brain barrier and brain cell membrane targeting agents; and one or more conjugation agents wherein each targeting agent is connected to the exterior surface of the nanocontainer via at least one of the conjugation agents.
In another aspect, the present invention provides a method for delivering DNA across a blood-brain barrier for expression in the brain. The method includes administering to a patient a composition including: an artificial adeno-associated virus (AAV) vector including DNA encoding a biologically active agent; and a component to deliver at least the DNA across the blood-brain barrier.
In another aspect, the present invention provides a method for delivering DNA across a blood-brain barrier for expression in the brain. The method includes administering to a patient a composition including a receptor-specific nanocontainer, wherein the receptor-specific nanocontainer includes: a nanoparticle or liposome having an exterior surface and an internal compartment; an artificial adeno-associated virus (AAV) vector located within the internal compartment of the nanocontainer, wherein the AAV vector includes DNA encoding a biologically active agent; one or more blood-brain barrier and brain cell membrane targeting agents; and one or more conjugation agents wherein each targeting agent is connected to the exterior surface of the nanocontainer via at least one of the conjugation agents.
In another aspect, the present invention provide artificial AAV vectors for delivering DNA encoding a biologically active agent, and methods of making and using such vectors.
In one embodiment, the present invention provides an artificial AAV vector including, in 5-prime to 3-prime order: a 5-prime AAV-ITR; a single stranded DNA encoding a biologically active agent; an internal AAV-ITR; a reverse complement of the single stranded DNA encoding the biologically active agent: and a 3-prime AAV-ITR. Methods of making such vectors are also provided.
In another embodiment, the present invention provides an artificial adeno-associated virus (AAV) vector for delivery of a linear, double stranded DNA encoding a biologically active agent, the artificial AAV vector including the linear, double stranded DNA having AAV-ITRs at the 5-prime and 3-prime ends of each strand. Preferably, the artificial AAV vector has been thermally treated in at least one heating and cooling cycle.
The present invention can offer advantages over other methods of delivering biologically active agents including, for example, conventional enhanced delivery, stereotactic neurosurgical delivery of viral or non-viral vectors, and/or intravenous delivery of a composition for carrying plasmid DNA or RNA across the blood brain barrier.
The use of an artificial AAV vector to deliver a gene or a gene-suppressing agent to a patient's brain can have many advantages over the delivery of plasmid DNA, or the delivery of actual AAV virus particles. One possible advantage of delivering the DNA of an AAV vector to the brain, rather than a plasmid DNA, is that expression of AAV-delivered gene constructs in the primate brain is known to persist for at least 3 to 4 years, whereas expression of gene constructs from plasmids is temporary. The advantages of delivering the DNA of a synthetic AAV vector over delivery of AAV virus particles can be several. First, delivery of just the DNA can circumvent the delivery of AAV viral capsids to the patient's brain. Since it is the AAV viral capsid proteins that are most likely to trigger an immune response, dispensing with the need to deliver viral particles can avoid most of the risk of adverse immune reactions to the therapy. Further, delivery of the DNA can circumvent the need to produce complete AAV particles, a difficult manufacturing step that requires the use of specially engineered and cultured cells to make the AAV capsids and package the DNA into the virus capsids. Finally, delivery of DNA rather than AAV particles can circumvent the natural limitation on the length of the DNA that can be packaged inside AAV capsids, which is about 4,700 bases of DNA. Although this size limitation is not a problem for delivery of constructs for gene suppression (e.g., DNA coding for small, interfering RNA), it can be a limitation for delivery of missing genes, if the sequence for the missing gene is longer than 4,700 bases, which has been noted as a limitation on the use of AAV as a vector for gene therapy.



DESCRIPTION OF THE FIGURES
FIG. 1 shows the assay (using a quantitative RT-PCR method known to those practiced in the art) of the ataxin1 mRNA obtained from HEK293H cells that have been transfected with plasmid containing an anti-ataxin1 ribozyme (top lanes in FIG. 1) or with siRNA against ataxin1 (bottom lanes of FIG. 1).
FIG. 2 shows the assay (using the same quantitative RT-PCR method known to those practiced in the art) of the ataxin-1 mRNA obtained from HEK293H cells that have been transfected with anti-ataxin-1 small interfering RNA (bottom lanes) compared to the mRNA obtained from HEK293H cells that have been transfected with a control siRNA that targets the mRNA for glyceraldehyde-3-phosphate dehydrogenase (GAPDH)
FIG. 3a shows the construction of the adeno-associated virus expression vector pAAV-siRNA as described in Example 3. FIG. 3b is a schematic representation of one embodiment of a self-complementary artificial AAV vector for delivery of a single stranded DNA. The artificial AAV vector includes, in 5-prime to 3-prime order: a 5-prime AAV-ITR (ITR); a single stranded DNA (α-BACE1/pCMV-EGFP); an internal AAV-ITR (ITR); a reverse complement of the single stranded DNA (α-BACE1/pCMV-EGFP); and a 3-prime AAV-ITR (ITR). FIG. 3c is a schematic representation of one embodiment of an artificial AAV vector for delivery of a linear, double stranded DNA. The linear, double stranded DNA (α-BACE1/pCMV-EGFP) has AAV-ITRs (ITR) at the 5-prime and 3-prime ends of each strand. FIG. 3d is a schematic representation of one embodiment of an artificial AAV vector for delivery of a linear, double stranded DNA as illustrated in FIG. 3c that has been thermally treated in at least one heating and cooling cycle. The schematic representation illustrates a secondary structure of the ITRs in which the ITRs have folded so as to allow the self-complementary portions of each ITR to internally hybridize.
FIG. 4 illustrates an investigational device (by Medtronic, Inc. of Minneapolis, Minn. Model 8506), which can be implanted subcutaneously on the cranium, and provides an access port through which therapeutic agents may be delivered to the brain.
FIG. 5 illustrates a cranium of a patient with an investigational device (by Medtronic, Inc. of Minneapolis, Minn.—schematic of Model 8506), implanted subcutaneously on the cranium, and provides an access port through which therapeutic agents may be delivered to the brain.
FIG. 6 illustrates diagrams of plasmids used. Plasmids pTracerBACE and pTracer-BACEmyc were used to screen for effective anti-BACE1 siRNA as described. Plasmid pMB1749 encoding for MB1749 as a shRNA was constructed as an intermediate step in the production of the viruses administered to mice as described, AAV-MB1749 and AAV-Control.
FIG. 7 illustrates western blot analysis of protein extracts from HEK293 cells transfected with a plasmid encoding a myc-tagged BACE1 or the parental myc-epitope plasmid, and optionally co-transfected with MB1749 or a scrambled control siRNA. Immunoblotting for the myc epitope shows suppression of BACE1 expression in cells co-transfected with MB1749 (leftmost lane). Re-blotting for GAPDH shows equivalent amounts of protein was loaded in each lane.
FIG. 8 illustrates fluorescence microscopy (left) and brightfield images (right, both 20× objective) showing GFP expression and BACE1 immunostaining respectively in example brain sections from a mouse treated with AAV-MB1749 (a,b) and a mouse treated with AAV-Control (c,d). The circled regions in the photographs designate regions of viral transduction (based on GFP expression). Levels of BACE1 immunoreactivity were reduced (p<0.002) in virally transduced regions in mice receiving AAV-MB1749.



DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
The present invention solves two problems in the prior art at the same time: (1) the problem of how to improve impaired memory function caused by the production in neurons of a protein that has pathogenic properties and (2) the problem of delivery of therapeutic small interfering RNA to affected neurons.
In the following descriptions, reference is made to the accompanying drawings that form a part hereof, and in which are shown by way of illustration several specific embodiments of the invention. It is to be understood that other embodiments of the present invention are contemplated and may be made without departing from the scope or spirit of the present invention. The following detailed description, therefore, is not to be taken in a limiting sense.
All scientific and technical terms used in this application have meanings commonly used in the art unless otherwise specified. The definitions provided herein are to facilitate understanding of certain terms used frequently herein and are not meant to limit the scope of the present disclosure.
TERMINOLOGY
By “alpha-synuclein, BACE1 (including variants thereof, e.g. variants A, B, C, and D), huntingtin, ataxin-1, ataxin-3, and/or atrophin-1 proteins” is meant, a protein or a mutant protein derivative thereof, comprising the amino-acid sequence expressed and/or encoded by alpha-synuclein (Parkinson's disease), and beta-site APP-cleaving enzyme (BACE1 (including variants thereof, e.g. variants A, B, C, and D)) (Alzheimer's disease), huntingtin (Huntington's disease), and ataxin-1 (Spinocerebellar Ataxia Type 1), ataxin-3 (Spinocerebellar Ataxia Type 3 or Machado-Joseph's Disease), and/or dentatorubral-pallidoluysian atrophy (DRPLA) genes and/or the human genomic DNA respectively.
As used herein “cell” is used in its usual biological sense, and does not refer to an entire multicellular organism. The cell may be present in an organism which may be a human but is preferably of mammalian origin, e.g., such as humans, cows, sheep, apes, monkeys, swine, dogs, cats, and the like. However, several steps of producing small interfering RNA may require use of prokaryotic cells (e.g., bacterial cell) or eukaryotic cell (e.g., mammalian cell) and thereby are also included within the term “cell”.
By “complementarity” it is meant that a molecule comprised of one or more nucleic acids (DNA or RNA) can form hydrogen bond(s) with another molecule comprised of one or more nucleic acids by either traditional Watson-Crick pairing or other non-traditional types.
By “equivalent” DNA to alpha-synuclein, BACE1 (including variants thereof, e.g. variants A, B, C, and D), huntingtin, ataxin-1, ataxin-3, and/or atrophin-1 it is meant to include those naturally occurring DNA molecules having homology (partial or complete) to DNA encoding for alpha-synuclein, BACE1 (including variants thereof, e.g. variants A, B, C, and D), huntingtin, ataxin-1, ataxin-3 and/or atrophin-1 proteins or encoding for proteins with similar function as alpha-synuclein, BACE1 (including variants thereof, e.g. variants A, B, C, and D), huntingtin, ataxin-1, ataxin-3 and/or atrophin-1 in various organisms, including human, rodent, primate, rabbit, pig, and microorganisms. The equivalent DNA sequence also includes regions such as the 5′-untranslated region, the 3′-untranslated region, introns, intron-exon junctions, small interfering RNA targeted site and the like, optionally incorporated into the DNA of infective viruses, such as adeno-associated virus (AAV).
The term “functional equivalent” refers to any derivative that is functionally similar to the reference sequence or protein. In particular the term “functional equivalent” includes derivatives in which the nucleotide bases(s) have been added, deleted, or replaced without a significant adverse effect on biological function.
As used herein, the term “biologically active” as used with “agent” or “siRNA” means that the agent or siRNA can modify a cell in any way including, for example, modifying the metabolism of the cell, the structure of the cell, the function of the cell, and/or permit the cell containing the agent or siRNA to be detected. Examples of biologically active agents and/or siRNAs include, for example, polynucleotides, polypeptides, and combinations thereof. A biologically active agent or siRNA may be therapeutic (i.e., able to treat or prevent a disease) or non-therapeutic (i.e., not directed to the treatment or prevention of a disease). Non-therapeutic biologically active compounds include detection or diagnostic agents including, for example, markers that can be used for detecting the presence of a particular cell, distinguishing cells, and/or detecting whether a targeting group is functioning to target a particular tissue. As used herein, the term “polynucleotide” or “nucleic acid molecule” refers to a polymeric form of nucleotides of any length, either ribonucleotides or deoxynucleotides, and includes both double- and single-stranded DNA and RNA, and combinations thereof. A polynucleotide may include nucleotide sequences having different functions including, for example, coding sequences and non-coding sequences such as regulatory sequences. Coding sequence, non-coding sequence, and regulatory sequence are defined below. A polynucleotide can be obtained directly from a natural source, or can be prepared with the aid of recombinant, enzymatic, or chemical techniques. A polynucleotide can be linear or circular in topology. A polynucleotide can be, for example, a portion of a vector, or a fragment.
A “coding sequence” or a “coding region” is a polynucleotide that encodes a polypeptide and, when placed under the control of appropriate regulatory sequences, expresses the encoded polypeptide. The boundaries of a coding region are generally determined by a translational start codon at its 5-prime end and a translational stop codon at its 3-prime end. A regulatory sequence is a nucleotide sequence that regulates expression of a coding region to which it is operably linked. Nonlimiting examples of regulatory sequences include promoters, transcriptional initiation sites, translational start sites, translational stop sites, transcriptional terminators (including, for example, polyadenylation signals), and intervening sequences (introns). “Operably linked” refers to a juxtaposition wherein the components so described are in a relationship permitting them to function in their intended manner. A regulatory sequence is “operably linked” to a coding region when it is joined in such a way that expression of the coding region is achieved under conditions compatible with the regulatory sequence.
By “gene” it is meant a region of DNA that controls the production of RNA. In context of producing functional small interfering RNA, this definition includes the necessary DNA sequence information encompassing the DNA sequences encoding the small interfering RNA, noncoding regulatory sequence and any included introns. The term “gene” is meant to include a polynucleotide that includes a coding sequence or coding region. The present definition does not exclude the possibility that additional genes encoding proteins may function in association or in tandem with the genes encoding small interfering RNA.
The term “vector” is commonly known in the art and defines a plasmid DNA, phage DNA, viral DNA and the like, which can serve as a DNA vehicle into which DNA of the present invention can be inserted, and from which RNA can be transcribed. The term “vectors” refers to any of these nucleic acid and/or viral-based techniques used to deliver a desired nucleic acid. Numerous types of vectors exist and are well known in the art.
The term “expression” defines the process by which a gene is transcribed into RNA (transcription); the RNA may be further processed into the mature small interfering RNA.
The terminology “expression vector” defines a vector or vehicle as described above but designed to enable the expression of an inserted sequence following transformation into a host. The cloned gene (inserted sequence) is usually placed under the control of control element sequences such as promoter sequences. The placing of a cloned gene under such control sequences is often referred to as being operably linked to control elements or sequences.
“Promoter” refers to a DNA regulatory region capable of binding directly or indirectly to RNA polymerase in a cell and initiating transcription of a downstream (3′ direction) coding sequence. For purposes of the present invention, the promoter is bound at its 3′ terminus by the transcription initiation site and extends upstream (5′ direction) to include the minimum number of bases or elements necessary to initiate transcription at levels detectable above background. Within the promoter will be found a transcription initiation site (conveniently defined by mapping with S1 nuclease), as well as protein binding domains (consensus sequences) responsible for the binding of RNA polymerase. Eukaryotic promoters will often, but not always, contain “TATA” boxes and “CCAT” boxes. Prokaryotic promoters contain −10 and −35 consensus sequences, which serve to initiate transcription.
By “homology” it is meant that the nucleotide sequence of two or more nucleic acid molecules is partially or completely identical.
By “highly conserved sequence region” it is meant that a nucleotide sequence of one or more regions in a target gene does not vary significantly from one generation to the other or from one biological system to the other.
By the term “inhibit” or “inhibitory” it is meant that the activity of the target genes or level of mRNAs or equivalent RNAs encoding target genes is reduced below that observed in the absence of the provided small interfering RNA. Preferably the inhibition is at least 10% less, 25% less, 50% less, or 75% less, 85% less, or 95% less than in the absence of the small interfering RNA.
By “inhibited expression” it is meant that the reduction of alpha-synuclein, BACE1 (including variants thereof, e.g. variants A, B, C, and D), huntingtin, ataxin-1, ataxin-3 and/or atrophin-1 mRNA levels and thus reduction in the level of the respective protein to relieve, to some extent, the symptoms of the disease or condition.
By “RNA” is meant ribonucleic acid, a molecule consisting of ribonucleotides connected via a phosphate-ribose(sugar) backbone. By “ribonucleotide” is meant guanine, cytosine, uracil, or adenine or some nucleotide with a hydroxyl group at the 2′ position of a beta-D-ribo-furanose moiety. As is well known in the art, the genetic code uses thymidine as a base in DNA sequences and uracil in RNA. One skilled in the art knows how to replace thymidine with uracil in a written nucleic acid sequence to convert a written DNA sequence into a written RNA sequence, or vice versa.
By “patient” is meant an organism, which is a donor or recipient of explanted cells or the cells themselves. “Patient” also refers to an organism to which the nucleic acid molecules of the invention can be administered. Preferably, a patient is a mammal or mammalian cells, e.g., such as humans, cows, sheep, apes, monkeys, swine, dogs, cats, and the like, or cells of these animals used for transplantation. More preferably, a patient is a human or human cells.
The term “synuclein” may refer to alpha-synuclein (especially human or mouse) or beta-synuclein (especially human or mouse). The full nucleotide sequence encoding human alpha-synuclein is available under Accession No AF163864 (SEQ ID NO:7). Two variants of the human alpha-synuclein sequence are available under Accession No NM—000345 (SEQ ID NO:14) and Accession No NM—007308 (SEQ ID NO:23). The mouse alpha-synuclein is available under Accession No. AF163865 (SEQ ID NO:10).
The term “BACE1” may refer to beta-site amyloid precursor protein cleaving enzyme type 1 (especially human or mouse). Several variants of BACE1 have been sequenced, including variants A, B, C, and D. In some scientific literature, BACE1 is also known as ASP2 and Memapsin2. The full nucleotide sequences encoding human BACE1, and variants related thereto, are available under Accession No. NM—138971 (SEQ ID NO:20), Accession No. NM—138972 (SEQ ID NO:19), Accession No. NM—138973 (SEQ ID NO:21), and Accession No. NM—012104 (SEQ ID NO:18). The sequence for a mouse homolog is available under accession number NM—011792 (SEQ ID NO:22).
The term “huntingtin” may refer to the protein product encoded by the Huntington's Disease gene (IT-15) (especially human or mouse). The full nucleotide sequence encoding human IT-15 is available under Accession No AH003045 (SEQ ID NO:9). The mouse sequence is available under Accession No. U24233 (SEQ ID NO:12).
The term “ataxin-1” may refer to the protein product encoded by the Spinocerebellar Ataxia Type 1 gene (especially human or mouse). The full nucleotide sequence encoding human SCA1 is available under Accession No NM—000332 (SEQ ID NO:15). The mouse sca1 is available under Accession No. NM—009124 (SEQ ID NO:13).
The term “ataxin-3” may refer to the protein product encoded by the Spinocerebellar Ataxia Type 3 gene (especially human or mouse). The full nucleotide sequence encoding human SCA3 is available under Accession No NM—004993 (splice variant 1) (SEQ ID NO:16), and NM—030660 (splice variant 2) (SEQ ID NO:17).
The term “atrophin-1” may refer to the protein product encoded by the dentatorubral-pallidolysian atrophy (DRPLA) gene (especially human or mouse).
The term “modification” includes derivatives substantially similar to the reference sequence or protein.
By “nucleic acid molecule” as used herein is meant a molecule having nucleotides. The nucleic acid can be single, double, or multiple stranded and may comprise modified or unmodified nucleotides or non-nucleotides or various mixtures and combinations thereof. An example of a nucleic acid molecule according to the invention is a gene which encodes for a small interfering RNA, even though it does not necessarily have its more common meaning for encoding for the production of protein.
By “small interfering RNA” is meant a nucleic acid molecule which has complementarity in a substrate binding region to a specified gene target, and which acts to specifically guide enzymes in the host cell to cleave the target RNA. That is, the small interfering RNA by virtue of the specificity of its sequence and its homology to the RNA target, is able to cause cleavage of the RNA strand and thereby inactivate a target RNA molecule because it is no longer able to be transcribed. These complementary regions allow sufficient hybridization of the small interfering RNA to the target RNA and thus permit cleavage. One hundred percent complementarity often necessary for biological activity and therefore is preferred, but complementarity as low as 90% may also be useful in this invention. The specific small interfering RNA described in the present application are not meant to be limiting and those skilled in the art will recognize that all that is important in a small interfering RNA of this invention is that it have a specific substrate binding site which is complementary to one or more of the target nucleic acid regions.
Small interfering RNAs are double stranded RNA agents that have complementary to (i.e., able to base-pair with) a portion of the target RNA (generally messenger RNA). Generally, such complementarity is 100%, but can be less if desired, such as 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99%. For example, bases out of 21 bases may be base-paired. In some instances, where selection between various allelic variants is desired, 100% complementary to the target gene is required in order to effectively discern the target sequence from the other allelic sequence. When selecting between allelic targets, choice of length is also an important factor because it is the other factor involved in the percent complementary and the ability to differentiate between allelic differences.
The small interfering RNA sequence needs to be of sufficient length to bring the small interfering RNA and target RNA together through complementary base-pairing interactions. The small interfering RNA of the invention may be of varying lengths. The length of the small interfering RNA is preferably greater than or equal to ten nucleotides and of sufficient length to stably interact with the target RNA; specifically 15-30 nucleotides; more specifically any integer between 15 and 30 nucleotides, such as 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, and 30. By “sufficient length” is meant an oligonucleotide of greater than or equal to 15 nucleotides that is of a length great enough to provide the intended function under the expected condition. By “stably interact” is meant interaction of the small interfering RNA with target nucleic acid (e.g., by forming hydrogen bonds with complementary nucleotides in the target under physiological conditions).
A “reverse complement” of a DNA strand in a 5-prime to 3-prime direction is a DNA strand in the reverse order with the corresponding complementary bases according to Watson-Crick or other base pairing rules.
By “comprising” is meant including, but not limited to, whatever follows the word “comprising”. Thus, use of the term “comprising” indicates that the listed elements are required or mandatory, but that other elements are optional and may or may not be present.
By “consisting of” is meant including, and limited to, whatever follows the phrase “consisting of”. Thus, the phrase “consisting of” indicates that the listed elements are required or mandatory, and that no other elements may be present.
By “consisting essentially of” is meant including any elements listed after the phrase, and limited to other elements that do not interfere with or contribute to the activity or action specified in the disclosure for the listed elements. Thus, the phrase “consisting essentially of” indicates that the listed elements are required or mandatory, but that other elements are optional and may or may not be present depending upon whether or not they affect the activity or action of the listed elements.
The present invention provides devices, systems and methods for improving memory and/or cognitive function through delivery of siRNA to a subject. In this aspect of the invention the method provides for improving memory function in a subject in need thereof, comprising administering to the subject a therapeutically effective dose of a composition that decreases the expression of a beta amyloid cleaving enzyme type 1, or BACE1, in a cell of the nervous system of the subject, wherein the composition comprises a small interfering RNA molecule specific for a BACE1 gene and wherein the small interfering RNA molecule specifically suppresses BACE1 gene expression in a cell of the nervous system of the subject.
Another aspect of the invention provides a method for improving memory function in a subject in need thereof, comprising modulating the expression or production of a beta amyloid cleaving enzyme type 1, or BACE1 protein in neurons by intracranial delivery of a small interfering RNA specific for a BACE1 gene that reduces said expression of production of said BACE1 protein, in a pharmaceutically acceptable carrier.
Another aspect of the present invention provides medical systems and methods for delivering DNA to a target site (e.g., to a cell or across the blood-brain barrier). The cell may be in vivo or ex vivo. As used herein, the term “ex vivo” refers to a cell that has been removed, for example, isolated, from the body of a subject. Ex vivo cells include, for example, primary cells (e.g., cells that have recently been removed from a subject and are capable of limited growth or maintenance in tissue culture medium), and cultured cells (e.g., cells that are capable of extended growth or maintenance in tissue culture medium). As used herein, the term “in vivo” refers to a cell that is within the body of a subject.
The medical systems include a neurovascular catheter having its distal end positioned in a blood vessel supplying a patient's brain. Optionally, the system further includes an implantable pump for delivery of the composition to the patient's blood stream. The medical system further includes a means for delivering to the catheter a composition as described herein. Methods of delivering such compositions to a cell or across the blood-brain barrier for expression in the brain are also described herein.
In brief, compositions disclosed and used in the present invention include an artificial adeno-associated virus (AAV) vector (single or double stranded vector; preferably a single stranded vector), including DNA encoding a biologically active agent; and a component (e.g., a receptor-specific liposome as described herein) that delivers at least the DNA across the blood-brain barrier. In some embodiments, the artificial AAV vector includes, in 5-prime to 3-prime order: a 5-prime AAV inverted terminal repeat (AAV-ITR); a single stranded DNA encoding the biologically active agent; and a 3-prime AAV-ITR. In other embodiments, the artificial AAV vector includes, in 5-prime to 3-prime order: a 5-prime AAV-ITR; a single stranded DNA encoding a biologically active agent; an internal AAV-ITR; a reverse complement of the single stranded DNA encoding the biologically active agent: and a 3-prime AAV-ITR. In still other embodiments, the artificial AAV vector includes a linear, double stranded DNA having AAV-ITRs at the 5-prime and 3-prime ends of each strand. Preferably, the artificial AAV vector does not include a coding sequence to encode a capsid, and thus, the preferred vectors are not encapsulated in a viral capsid structure. Methods of making artificial AAV vectors are also disclosed.
For embodiments in which the DNA encodes a small interfering RNA, the compositions can be useful for treating, among other things, various neurodegenerative disorders caused by a pathogenic protein. For embodiments in which the DNA encodes a protein, the compositions can be useful for treating, among other things, various neurological diseases caused by the absence of the protein.
In some embodiments, the compositions include a receptor-specific liposome and a pharmaceutically acceptable carrier for the receptor-specific liposome, wherein the receptor-specific liposome includes: a liposome having an exterior surface and an internal compartment; the artificial adeno-associated virus (AAV) vector located within the internal compartment of the liposome; one or more blood-brain barrier and brain cell membrane targeting agents; and one or more conjugation agents, wherein each targeting agent is connected to the exterior surface of the liposome via at least one of the conjugation agents.
In other embodiments, the compositions include a receptor-specific nanocontainer (i.e., a container having at least one dimension on the order of a few nanometers or less) and a pharmaceutically acceptable carrier for the receptor-specific nanocontainer, wherein the receptor-specific nanocontainer includes: a nanocontainer having an exterior surface and an internal compartment; an artificial adeno-associated virus (AAV) vector located within the internal compartment of the nanocontainer; one or more receptor specific targeting agents that target the receptor located on the cell; and one or more conjugation agents, wherein each targeting agent is connected to the exterior surface of the nanocontainer via at least one of the conjugation agents.
Another aspect of the invention provides a method of delivering a small interfering RNA to a location in the brain of a subject suffering from memory impairment comprising the steps of: a) surgically implanting an intracranial access delivery device; and b) infusing a small interfering RNA and/or a vector encoding said small interfering RNA at a predetermined site in the brain, wherein at least one attribute of memory function is improved.
Another aspect of the invention provides a method for improving memory function in a subject comprised of modulating the expression or production of a beta amyloid cleaving enzyme type 1, or BACE1 protein in neurons by intracranial delivery of a small interfering RNA from SEQ ID NOS: 24-40 that reduces said expression of production of said BACE1 protein, in a pharmaceutically acceptable carrier.
Another aspect of the invention provides a method of delivering a small interfering RNA to a location in the brain of a subject suffering from memory impairment comprising the steps of: a) surgically implanting an intracranial access delivery device; and b) infusing a small interfering RNA and/or a vector encoding said small interfering RNA containing one or more sequences coded from SEQ ID NOS: 24-40 at a predetermined site in the brain; wherein at least one attribute of said memory impairment is improved.
Another aspect of the invention provides a medical system for improving memory function in a subject comprising: a) an intracranial access device; b) a mapping means for locating a predetermined location in the brain; c) a deliverable amount of a small interfering RNA or vector encoding said small interfering RNA selected from one or more sequences coded from SEQ ID NOS: 24-40; and d) a delivery means for delivering said small interfering RNA or vector encoding said small interfering RNA to said location of the brain from said intracranial access device.
Medical Devices
The present invention also provides medical devices that include a neurovascular catheter and an optional implantable pump for delivery of the composition into a patient's blood stream. The distal, delivery end of the neurovascular catheter is positioned in a blood vessel supplying the brain. For acute use, the proximal end of the neurovascular catheter would remain outside the patient's body at the point of introduction (e.g., the femoral artery) and used by the physician to deliver the composition in a suitable fluid solution to the patient's brain. Although the delivery in this case is acute, the therapy may nevertheless be long-lasting as described herein below.
Alternatively, the proximal end of the neurovascular catheter can be attached to the optional implantable pump, and both the pump and catheter chronically implanted in the body. In the latter case, the pump provides a “catheter access port” through which the physician can transcutaneously make repeated bolus injections of the composition through the catheter into the blood vessel supplying the patient's brain. The pump provides a fluid reservoir used to supply heparinized saline, dilute tissue plasminogen activator (tPA), or a similar agent that is continuously pumped at a low rate through the neurovascular catheter in between uses of the catheter for bolus injections. The purpose is to prevent blood clots from forming at the distal end of the catheter, occluding the catheter lumen and posing a risk of embolic stroke to the patient.
Using the small interfering RNA vectors previously described, the present invention also provides devices, systems, and methods for delivery of small interfering RNA to target locations of the brain. The envisioned route of delivery is through the use of implanted, indwelling, intraparenchymal catheters that provide a means for injecting small volumes of fluid containing AAV or other vectors directly into local brain tissue. The proximal end of these catheters may be connected to an implanted, intracerebral access port surgically affixed to the patient's cranium, or to an implanted drug pump located in the patient's torso.
Examples of the delivery devices within the scope of the present invention include the Model 8506 investigational device (by Medtronic, Inc. of Minneapolis, Minn.), which can be implanted subcutaneously on the cranium, and provides an access port through which therapeutic agents may be delivered to the brain. Delivery occurs through a stereotactically implanted polyurethane catheter. The Model 8506 is schematically depicted in FIGS. 4 and 5. Briefly, referring to FIG. 4, the device comprises a catheter 10. The catheter 10 is secured to the intracranial access port 12 which may optionally have strain relief 14. The catheter is also secured to the skull of the patient by anchor 16. FIG. 5 shows the device illustrated in FIG. 4 implanted into the patient, as shown by the saggital view of the patient's head 18. The intracranial access port 12 is implanted subcutaneously on the cranium of the patient. The catheter 10 extends through the relief strain 14 and is secured by the anchor 16 to the patient's skull. The distal tip of the catheter 10 is located in the predetermined location in the patient's brain. It is preferred to place some means for locating the distal end of the catheter 10 during the access and location process. This is preferably done by applying a marker, to the distal end of the catheter which is detected during the access and location process. If access and location is accomplished using some form of x-ray radiation, the marker is preferably radiopaque. Radiopaque marker renders at least a portion of distal tip opaque to x-rays, enabling the tip to be observed via fluoroscopy or via x-ray during access and location of catheter 10. In a preferred embodiment, radiopaque marker comprises tantalum powder dispersed in a matrix composed of a biocompatible adhesive, such as those discussed above. Other materials may also be suitable for radiopaque marker, such as barium or platinum materials. Alternately, the radiographic marker may be chosen of a material that has sufficient radiodensity for visualization during radiologic procedures, but in powdered form that is dispersed in the catheter tip at the time the distal tip of the catheter is molded. Alternatively, the marker may be composed of a material that is compatible to nuclear magnetic resonance imaging (MRI) to enable the distal tip of the catheter 10 to be detected during an MRI scan. Preferred material for such a marker is platinum, though barium, tantalum, and similar materials are also suitable. Regardless of whether radiography or MRI is being utilized, the goal of providing a radiographic marker is to enable the operator to accurately detect the precise location of the distal tip of the catheter to facilitate placement and later verification of the integrity and position of the distal tip of catheter 10. Two models of catheters that can function with the Model 8506 access port include the Model 8770 ventricular catheter by Medtronic, Inc., for delivery to the intracerebral ventricles, which is disclosed in U.S. Pat. No. 6,093,180, incorporated herein by reference, and the IPA1 catheter by Medtronic, Inc., for delivery to the brain tissue itself (i.e., intraparenchymal delivery), disclosed in U.S. Ser. Nos. 09/540,444 (U.S. Pat. No. 6,551,290) and 09/625,751 (U.S. Pat. No. 6,945,969), which are incorporated herein by reference. The latter catheter has multiple outlets on its distal end to deliver the therapeutic agent to multiple sites along the catheter path. In addition to the aforementioned device, the delivery of the small interfering RNA vectors in accordance with the present invention can be accomplished with a wide variety of devices, including but not limited to U.S. Pat. Nos. 5,735,814, 5,814,014, and 6,042,579, all of which are incorporated herein by reference. Using the teachings of the present invention and those of skill in the art will recognize that these and other devices and systems may be suitable for delivery of small interfering RNA vectors for the treatment of neurodegenerative diseases in accordance with the present invention.
In one preferred embodiment, the method further comprises the steps of implanting a pump outside the brain, the pump coupled to a proximal end of the catheter, and operating the pump to deliver the predetermined dosage of the at least one small interfering RNA or small interfering RNA vector through the discharge portion of the catheter. A further embodiment comprises the further step of periodically refreshing a supply of the at least one small interfering RNA or small interfering RNA vector to the pump outside said brain.
Thus, the present invention includes the delivery of small interfering RNA vectors using an implantable pump and catheter, like that taught in U.S. Pat. Nos. 5,735,814 and 6,042,579, and further using a sensor as part of the infusion system to regulate the amount of small interfering RNA vectors delivered to the brain, like that taught in U.S. Pat. No. 5,814,014. Other devices and systems can be used in accordance with the method of the present invention, for example, the devices and systems disclosed in U.S. Ser. Nos. 09/872,698 (filed Jun. 1, 2001) and 09/864,646 (filed May 23, 2001), which are incorporated herein by reference.
The design and use of small interfering RNA complementary to mRNA targets that produce particular proteins is a recent tool employed by molecular biologists to prevent translation of specific mRNAs. Other tools used by molecular biologists to interfere with protein expression prior to translation involve cleavage of the mRNA sequences using ribozymes against therapeutic targets for Alzheimer's disease (see, for example, PCT International Application Publication No. WO 01/16312 A2 (McSwiggen et al.)) and Parkinson's disease (see, for example, PCT International Application Publication Nos. WO 99/50300 A1 (Trojanowski et al.) and WO 01/60794 A2 (Eliezer)). PCT International Application Publication No. WO 2004/047872 A2 (Kaemmerer) and U.S. Patent Application Publication No. 2004/0220132 A1 (Kaemmerer) disclose devices, small interfering RNA, and methods for treating a neurodegenerative disorder including the steps of surgically implanting a catheter so that a discharge portion of the catheter lies adjacent to a predetermined infusion site in a brain, and discharging through the discharge portion of the catheter a predetermined dosage of at least one substance that inhibits production of at least one neurodegenerative protein. PCT International Application Publication No. WO 2004/047872 A2 (Kaemmerer) and U.S. Patent Application Publication No. 2004/0220132 A1 (Kaemmerer) further disclose small interfering RNA vectors, and methods for treating neurodegenerative disorders such as Alzheimer's disease, Parkinson's disease, Huntington's disease, Spinocerebellar Ataxia Type 1, Type 2, Type 3, and/or dentatorubral-pallidoluysian atrophy.
As previously indicated, the small interfering RNA (or siRNA) described herein, is a segment of double stranded RNA that is from 15 to 30 nucleotides in length. It is used to trigger a cellular reaction known as RNA interference. In RNA interference, double-stranded RNA is digested by an intracellular enzyme known as Dicer, producing siRNA duplexes. The siRNA duplexes bind to another intracellular enzyme complex which is thereby activated to target whatever mRNA molecules are homologous (or complementary) to the siRNA sequence. The activated enzyme complex cleaves the targeted mRNA, destroying it and preventing it from being used to direct the synthesis of its corresponding protein product.
Recent evidence suggests that RNA interference is an ancient, innate mechanism for not only defense against viral infection (many viruses introduce foreign RNA into cells) but also gene regulation at very fundamental levels. RNA interference has been found to occur in plants, insects, lower animals, and mammals, and has been found to be dramatically more effective than other gene silencing technologies, such as antisense or ribozymes. Used as a biotechnology, siRNA involves introducing into cells (or causing cells to produce) short, double-stranded molecules of RNA similar to those that would be produced by the Dicer enzyme from an invading double-stranded RNA virus. The artificially-triggered RNA interference process then continues from that point.
To deliver a small interfering RNA to a patient's brain, a preferred method will be to introduce the DNA encoding for the siRNA, rather than the siRNA molecules themselves, into the cells of the brain. The DNA sequence encoding for the particular therapeutic siRNA can be specified upon knowing (a) the sequence for a small and accessible portion of the target mRNA (available in public human genome databases), and (b) well-known scientific rules for how to specify DNA that will result in production of a corresponding RNA sequence when the DNA is transcribed by cells. The DNA sequence, once specified, can be constructed in the laboratory from synthetic molecules ordered from a laboratory supplier, and inserted using standard molecular biology methods into one of several alternative “vectors” for delivery of DNA to cells. Once delivered into the neurons of the patient's brain, those neurons will themselves produce the RNA that becomes the therapeutic siRNA, by transcribing the inserted DNA into RNA. The result will be that the cells themselves produce the siRNA that will silence the targeted gene. The result will be a reduction of the amount of the targeted protein produced by the cell.
Small Interfering RNA and Small Interfering RNA Vectors
In accordance with the present invention, small interfering RNA against specific mRNAs produced in the affected cells prevent the production of the disease related proteins in neurons. In accordance with the present invention is the use of specifically tailored vectors designed to deliver small interfering RNA to targeted cells. The success of the designed small interfering RNA is predicated on their successful delivery to the targeted cells of the brain to treat the neurodegenerative diseases.
Small interfering RNA have been shown to be capable of targeting specific mRNA molecules in human cells. Small interfering RNA vectors can be constructed to transfect human cells and produce small interfering RNA that cause the cleavage of the target RNA and thereby interrupt production of the encoded protein.
A small interfering RNA vector of the present invention will prevent production of the pathogenic protein by suppressing production of the neuropathogenic protein itself or by suppressing production of a protein involved in the production or processing of the neuropathogenic protein. Repeated administration of the therapeutic agent to the patient may be required to accomplish the change in a large enough number of neurons to improve the patient's quality of life. Within an individual neuron, however, the change is longstanding enough to provide a therapeutic benefit. The desperate situation of many patients suffering from neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Huntington's disease, or Spinocerebellar Ataxia Type 1 provides a strong likelihood that the benefit from the therapy will outweigh the risks of the therapy delivery and administration. While it may be possible to accomplish some reduction in the production of neuropathogenic proteins with other therapeutic agents and routes of administration, development of successful therapies involving direct in vivo transfection of neurons may provide the best approach based on delivery of small interfering RNA vectors to targeted cells.
The preferred vector for delivery of foreign DNA to neurons in the brain is adeno-associated virus (AAV), such as recombinant adeno-associated virus serotype 2 or recombinant adeno-associated virus serotype 5. Alternatively, other viral vectors, such as herpes simplex virus, may be used for delivery of foreign DNA to central nervous system neurons. It is also possible that non-viral vectors, such as plasmid DNA delivered alone or complexed with liposomal compounds or polyethyleneimine, may be used to deliver foreign DNA to neurons in the brain.
It is important to note that the anti-ataxin-1 small interfering RNA and the anti-BACE1 small interfering RNA illustrated here, as well as the other small interfering RNAs for treating neurodegenerative disorders, are just but some examples of the embodiment of the invention. Experimentation using neurosurgical methods with animals, known to those practiced in neuroscience, can be used to identify the candidate small interfering RNAs. The target site on the mRNA and the corresponding small interfering RNA identified by these empirical methods will be the one that will lead to the greatest therapeutic effect when administered to patients with the subject neurodegenerative disease.
In reference to the nucleic molecules of the present invention, the small interfering RNA are targeted to complementary sequences in the mRNA sequence coding for the production of the target protein, either within the actual protein coding sequence, or in the 5′ untranslated region or the 3′ untranslated region. After hybridization, the host enzymes guided by the siRNA are capable of cleavage of the mRNA sequence. Perfect or a very high degree of complementarity is needed for the small interfering RNA to be effective. A percent complementarity indicates the percentage of contiguous residues in a nucleic acid molecule that can form hydrogen bonds (e.g., Watson-Crick base pairing) with a second nucleic acid sequence (e.g., 5, 6, 7, 8, 9, 10 out of 10 being 50%, 60%, 70%, 80%, 90%, and 100% complementary). “Perfectly complementary” means that all the contiguous residues of a nucleic acid sequence will hydrogen bond with the same number of contiguous residues in a second nucleic acid sequence. However, it should be noted that single mismatches, or base-substitutions, within the siRNA sequence can substantially reduce the gene silencing activity of a small interfering RNA.
In preferred embodiments of the present invention, a small interfering RNA is 15 to 30 nucleotides in length. In particular embodiments, the nucleic acid molecule is 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, or 30 nucleotides in length. In preferred embodiments the length of the siRNA sequence can be between 19-30 base pairs, and more preferably between 21 and 25 base pairs, and more preferably between 21 and 23 base pairs.
In a preferred embodiment, the invention provides a method for producing a class of nucleic acid-based gene inhibiting agents that exhibit a high degree of specificity for the RNA of a desired target. For example, the small interfering RNA is preferably targeted to a highly conserved sequence region of target RNAs encoding BACE1 (including variants thereof, e.g. variants A, B, C, and D), RNA such that specific treatment of a disease or condition can be provided with either one or several nucleic acid molecules of the invention. Further, generally, interfering RNA sequences are selected by identifying regions in the target sequence that begin with a pair of adenine bases (AA) (see Examples). SiRNAs can be constructed in vitro or in vivo using appropriate transcription enzymes or expression vectors.
SiRNAs can be constructed in vitro using DNA oligonucleotides. These oligonucleotides can be constructed to include an 8 base sequence complementary to the 5′ end of the T7 promoter primer included in the Silencer siRNA (Ambion Construction Kit 1620). Each gene specific oligonucleotide is annealed to a supplied T7 promoter primer, and a fill-in reaction with Klenow fragment generates a full-length DNA template for transcription into RNA. Two in vitro transcribed RNAs (one the antisense to the other) are generated by in vitro transcription reactions and then hybridized to each other to make double-stranded RNA. The double-stranded RNA product is treated with DNase (to remove the DNA transcription templates) and RNase (to polish the ends of the double-stranded RNA), and column purified to provide the siRNA that can be delivered and tested in cells.
Construction of siRNA vectors that express siRNAs within mammalian cells typically use an RNA polymerase III promoter to drive expression of a short hairpin RNA that mimics the structure of an siRNA. The insert that encodes this hairpin is designed to have two inverted repeats separated by a short spacer sequence. One inverted repeat is complementary to the mRNA to which the siRNA is targeted. A string of six consecutive thymidines added to the 3′ end serves as a pol III transcription termination site. Once inside the cell, the vector constitutively expresses the hairpin RNA. The hairpin RNA is processed into an siRNA which induces silencing of the expression of the target gene, which is called RNA interference (RNAi).
In most siRNA expression vectors described to date, one of three different RNA polymerase III (pol III) promoters is used to drive the expression of a small hairpin siRNA (1-5). These promoters include the well-characterized human and mouse U6 promoters and the human H1 promoter. RNA pol III was chosen to drive siRNA expression because it expresses relatively large amounts of small RNAs in mammalian cells and it terminates transcription upon incorporating a string of 3-6 uridines.
The constructed nucleic acid molecules can be delivered exogenously to specific tissue or cellular targets as required. Alternatively, the nucleic acid molecules (e.g., small interfering RNA) can be expressed from DNA plasmid, DNA viral vectors, and/or RNA retroviral vectors that are delivered to specific cells.
The delivered small nuclear RNA sequences delivered to the targeted cells or tissues are nucleic acid-based inhibitors of BACE1 (including variants thereof, e.g. variants A, B, C, and D), that are useful for the prevention of the neurodegenerative diseases including Alzheimer's disease, memory loss or cognitive dysfunction, and any other diseases or conditions related to the level of BACE1 and/or beta-amyloid in a cell or tissue.
The nucleic acid-based inhibitors of the invention are added directly, or can be complexed with cationic lipids, packaged within liposomes, packaged within viral vectors, or otherwise delivered to target cells or tissues. The nucleic acid or nucleic acid complexes can be locally administered to relevant tissues ex vivo, or in vivo through injection, infusion pump or stent, with or without their incorporation in biopolymers. In preferred embodiments, the nucleic acid inhibitors comprise sequences which are a sufficient length and/or stably interact with their complementary substrate sequences identified in SEQ ID NOS: 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53. Examples of such small interfering RNA (siRNA) also are shown in SEQ ID NOS: 1, 2, 3, 4, for SEQ ID NOS: relating to siRNAs suppressing Ataxin1 mRNA (see also Examples 1-3). Examples of such small interfering RNA are shown in SEQ ID NOS: 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, or 40 relating to suppressing BACE1 mRNA (see also all of Examples 4-6). Examples of such small interfering RNA are shown in SEQ ID NOS: 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, and 53 relating to siRNAs suppressing Huntington mRNA.
In another aspect, the invention provides mammalian cells containing one or more nucleic acid molecules and/or expression vectors of this invention. The one or more nucleic acid molecules may independently be targeted to the same or different sites.
In another aspect of the invention, small interfering RNA molecules that interact with target RNA molecules and inhibit alpha-synuclein, BACE1 (including variants thereof, e.g. variants A, B, C, and D), huntingtin, ataxin-1, ataxin-3 and/or atrophin-1 RNA activity are expressed from transcription units inserted into DNA or RNA vectors. The recombinant vectors are preferably DNA plasmids or viral vectors. Small interfering RNA expressed from viral vectors could be constructed based on, but not limited to, the vector sequences of adeno-associated virus, retrovirus, or adenovirus. Preferably, the recombinant vectors capable of expressing the small interfering RNA are delivered as described above, and persist in target cells. Alternatively, viral vectors may be used that provide for transient expression of small interfering RNA. Such vectors might be repeatedly administered as necessary. Once expressed, the small interfering RNA bind to the target RNA and through use of the host machinery inhibit its expression and thereby its function. Delivery of small interfering RNA expressing vectors, or the small interfering RNA themselves, is by use of intracranial access devices.
The nucleic acid molecules of the instant invention, individually, or in combination or in conjunction with other drugs, can be used to treat diseases or conditions discussed above. For example, to treat a disease or condition associated with alpha-synuclein (Parkinson's Disease), and beta-site APP-cleaving enzyme (Alzheimer's Disease), huntingtin (Huntington's Disease), and Ataxin 1 (Spinocerebellar Ataxia), the patient may be treated, or other appropriate cells may be treated, as is evident to those skilled in the art, individually or in combination with one or more drugs under conditions suitable for the treatment.
In a further embodiment, the described small interfering RNA can be used in combination with other known treatments to treat conditions or diseases discussed above.
In another preferred embodiment, the invention provides nucleic acid-based inhibitors (e.g., small interfering RNA) and methods for their use to downregulate or inhibit the expression of RNA (e.g., alpha-synuclein, BACE1 (including variants thereof, e.g. variants A, B, C, and D), huntingtin, ataxin-1, ataxin-3 and/or atrophin-1) coding for proteins involved in the progression and/or maintenance of Parkinson's disease, Alzheimer's disease, Huntington's disease, Spinocerebellar Ataxia Type 1, Spinocerebellar Ataxia Type 3, and dentatorubral-pallidoluysian atrophy.
The present invention also provides nucleic acid molecules that can be expressed within cells from known eukaryotic promoters (e.g., Izant and Weintraub, 1985, Science, 229, 345; McGarry and Lindquist, 1986, Proc. Natl. Acad. Sci., USA 83, 399; Scanlon et al., 1991, Proc. Natl. Acad. Sci. USA, 88, 10591-5; Kashani-Sabet et al., 1992, Antisense Res. Dev., 2, 3-15; propulic et al., 1992, J Virol., 66, 1432-41; Weerasinghe et al., 1991, J Virol., 65, 5531-4; Ojwang et al., 1992, Proc. Natl. Acad. Sci. USA, 89, 10802-6; Chen et al., 1992, Nucleic Acids Res., 20, 4581-9; Sarver et al., 1990 Science, 247, 1222-1225; Thompson et al., 1995, Nucleic Acids Res., 23, 2259; Good et al., 1997, Gene Therapy, 4, 45; all of these references are hereby incorporated herein, in their totalities, by reference). Those skilled in the art realize that any nucleic acid can be expressed in eukaryotic cells from the appropriate DNA/RNA vector. The activity of such nucleic acids can be augmented by their release from the primary transcript by ribozymes (Draper et al., PCT WO 93/23569, and Sullivan et al., PCT WO 94/02595; Ohkawa et al., 1992, Nucleic Acids Symp. Ser., 27, 15-6; Taira et al., 1991, Nucleic Acids Res., 19, 5125-30; Ventura et al., 1993, Nucleic Acids Res., 21, 3249-55; Chowrira et al., 1994, J Biol. Chem., 269, 25856; all of these references are hereby incorporated in their totality by reference herein).
In another aspect of the invention, RNA molecules of the present invention are preferably expressed from transcription units (see, for example, Couture et al., 1996, TIG., 12, 5-10) inserted into DNA or RNA vectors. The recombinant vectors are preferably DNA plasmids or viral vectors. Small interfering RNA expressing viral vectors could be constructed based on, but not limited to, adeno-associated virus, retrovirus, adenovirus, or alphavirus.
In one aspect, the invention features an expression vector comprising a nucleic acid sequence encoding at least one functional segment of the nucleic acid molecules of the instant invention. The nucleic acid sequence encoding the nucleic acid molecule of the instant invention is operably linked in a manner which allows expression of that nucleic acid molecule.
In another aspect the invention features an expression vector comprising: a) a transcription initiation region (e.g., eukaryotic pol I, II or III initiation region); b) a nucleic acid sequence encoding at least one of the nucleic acid agents of the instant invention; and c) a transcription termination region (e.g., eukaryotic pol I, II or III termination region); wherein said sequence is operably linked to said initiation region and said termination region, in a manner which allows expression and/or delivery of said nucleic acid molecule.
Transcription of the nucleic acid molecule sequences are driven from a promoter for eukaryotic RNA polymerase I (pol 1), RNA polymerase II (pol II), or RNA polymerase III (pol III) as is known and appreciated in the art. All of these references are incorporated by reference herein. Several investigators have demonstrated that RNA molecules can be expressed from such promoters can function in mammalian cells (e.g. Kashani-Sabet et al., 1992, Antisense Res. Dev., 2, 3-15; Ojwang et al., 1992, Proc. Natl. Acad Sci. USA, 89, 10802-6; Chen et al., 1992, Nucleic Acids Res., 20, 4581-9; Yu et al., 1993, Proc. Natl. Acad Sci. USA, 90, 6340-4; L'Huillier et al., 1992, EMBO J, 11, 4411-8; Lisziewicz et al., 1993, Proc. Natl. Acad. Sci. U.S. A, 90, 8000-4; Thompson et al., 1995, Nucleic Acids Res., 23, 2259; Sullenger & Cech, 1993, Science, 262, 1566). More specifically, transcription units such as the ones derived from genes encoding U6 small nuclear (snRNA), transfer RNA (tRNA) and adenovirus VA RNA are useful in generating high concentrations of desired RNA molecules such as small interfering RNA in cells (Thompson et al., supra; Couture and Stinchcomb, 1996, supra; Noonberg et al., 1994, Nucleic Acid Res., 22, 2830; Noonberg et al., U.S. Pat. No. 5,624,803; Good et al., 1997, Gene Ther., 4, 45; Beigelman et al., International PCT Publication No. WO 96118736; all of these publications are incorporated by reference herein). The above small interfering RNA transcription units can be incorporated into a variety of vectors for introduction into mammalian cells, including but not restricted to, plasmid DNA vectors, viral DNA vectors (such as adenovirus or adeno-associated virus vectors), or viral RNA vectors (such as retroviral or alphavirus vectors) (for a review see Couture and Stinchcomb, 1996, supra).
It should be noted that the exemplified methods for constructing the small interfering RNA to be used as the therapeutic agents in the invention (that is, in vitro transcription from DNA templates and assembly into double-stranded RNA, or cloning the DNA coding for a hairpin structure of RNA into an adeno-associated viral expression vector) are only two possible means for making the therapeutic small interfering RNA. Other larger scale, more efficient methods for manufacturing small interfering RNA may be used to produce the clinical grade and clinical quantities used for treating human patients, without altering the essence of the invention.
Those of skill in the art are familiar with the principles and procedures discussed in widely known and available sources as Remington's Pharmaceutical Science (17th Ed., Mack Publishing Co., Easton, Pa., 1985) and Goodman and Gilman's The Pharmaceutical Basis of Therapeutics (8th Ed., Pergamon Press, Elmsford, N.Y., 1990) both of which are incorporated herein by reference.
In a preferred embodiment of the present invention, the composition comprising the siRNA agent or precursors or derivatives thereof is formulated in accordance with standard procedure as a pharmaceutical composition adapted for delivered administration to human beings and other mammals. Typically, compositions for intravenous administration are solutions in sterile isotonic aqueous buffer.
Where necessary, the composition may also include a solubilizing agent and a local anesthetic to ameliorate any pain at the site of the injection. Generally, the ingredients are supplied either separately or mixed together in unit dosage form, for example, as a dry lyophilized powder or water free concentrate in a hermetically sealed container such as an ampule or sachette indicating the quantity of active agent. Where the composition is to be administered by infusion, it can be dispensed with an infusion bottle containing sterile pharmaceutical grade water or saline. Where the composition is administered by injection, an ampule of sterile water for injection or saline can be provided so that the ingredients may be mixed prior to administration.
In cases other than intravenous administration, the composition can contain minor amounts of wetting or emulsifying agents, or pH buffering agents. The composition can be a liquid solution, suspension, emulsion, gel, polymer, or sustained release formulation. The composition can be formulated with traditional binders and carriers, as would be known in the art. Formulations can include standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharide, cellulose, magnesium carbonate, etc., inert carriers having well established functionality in the manufacture of pharmaceuticals. Various delivery systems are known and can be used to administer a therapeutic of the present invention including encapsulation in liposomes, microparticles, microcapsules and the like.
In yet another preferred embodiment, therapeutics containing small interfering RNA or precursors or derivatives thereof can be formulated as neutral or salt forms. Pharmaceutically acceptable salts include those formed with free amino groups such as those derived from hydrochloric, phosphoric, acetic, oxalic, tartaric acids and the like, and those formed with free carboxyl groups such as those derived from sodium, potassium, ammonium, calcium, ferric hydroxides, isopropylamine, thriethylamine, 2-ethylamino ethanol, histidine, procaine or similar.
The amount of the therapeutic of the present invention which will be effective in the treatment of a particular disorder or condition will depend on the nature of the disorder or condition, and can be determined by standard clinical techniques, well established in the administration of therapeutics. The precise dose to be employed in the formulation will also depend on the route of administration, and the seriousness of the disease or disorder, and should be decided according to the judgment of the practitioner and the patient's needs. Suitable dose ranges for intracranial administration are generally about 103 to 1015 infectious units of viral vector per microliter delivered in 1 to 3000 microliters of single injection volume. Addition amounts of infections units of vector per micro liter would generally contain about 104, 105, 106, 107, 108, 109, 1010, 1011, 1012, 1013, 1014 infectious units of viral vector delivered in about 10, 50, 100, 200, 500, 1000, or 2000 microliters. Effective doses may be extrapolated from dose-responsive curves derived from in vitro or in vivo test systems.
For the small interfering RNA vector therapy for neurodegenerative disease of the present invention, multiple catheters having access ports can be implanted in a given patient for a complete therapy. In a preferred embodiment, there is one port and catheter system per cerebral or cerebellar hemisphere, and perhaps several. Once the implantations are performed by a neurosurgeon, the patient's neurologist can perform a course of therapy consisting of repeated bolus injections of small interfering RNA expression vectors over a period of weeks to months, along with monitoring for therapeutic effect over time. The devices can remain implanted for several months or years for a full course of therapy. After confirmation of therapeutic efficacy, the access ports might optionally be explanted, and the catheters can be sealed and abandoned, or explanted as well. The device material should not interfere with magnetic resonance imaging, and, of course, the small interfering RNA preparations must be compatible with the access port and catheter materials and any surface coatings.
The polymerase chain reaction (PCR) used in the construction of siRNA expression plasmids and/or viral vectors is carried out in accordance with known techniques. See, e.g., U.S. Pat. Nos. 4,683,195; 4,683,202; 4,800,159; and 4,965,188 (the disclosures of all three U.S. patent are incorporated herein by reference). In general, PCR involves a treatment of a nucleic acid sample (e.g., in the presence of a heat stable DNA polymerase) under hybridizing conditions, with one oligonucleotide primer for each strand of the specific sequence to be detected. An extension product of each primer which is synthesized is complementary to each of the two nucleic acid strands, with the primers sufficiently complementary to each strand of the specific sequence to hybridize therewith. The extension product synthesized from each primer can also serve as a template for further synthesis of extension products using the same primers. Following a sufficient number of rounds of synthesis of extension products, the sample is analyzed to assess whether the sequence or sequences to be detected are present. Detection of the amplified sequence may be carried out by visualization following EtBr staining of the DNA following gel electrophoresis, or using a detectable label in accordance with known techniques, and the like. For a review on PCR techniques (see PCR Protocols, A Guide to Methods and Amplifications, Michael et al. Eds, Acad. Press, 1990).
Artificial AAV Vector
An artificial AAV vector includes DNA encoding a biologically active agent, and can be used to deliver a gene or a gene-suppressing agent to a patient's neurons. Thus, the artificial AAV preferably includes a cassette to deliver a gene, or a cassette to deliver a gene-suppressing agent. For example, in the case of a gene therapy intended to supply a missing gene to the patient's brain, the expression cassette can include a promoter element, the coding sequence for the missing gene, and a polyadenylation signal sequence. For another example, in the case of a gene suppression therapy intended to suppress the expression of an endogenous gene in the patient's brain, the expression cassette can include a promoter element, the coding sequence for a small, interfering RNA (siRNA), and a termination sequence.
In one embodiment, the artificial AAV vector is a double stranded vector. The double stranded vector, which may include either type of expression cassette, includes a 5-prime copy of the inverted terminal repeat (AAV-ITR) from the adeno-associated virus genome, followed by an expression cassette for a gene or gene-suppressing agent (whose identity depends upon the neurological disorder to be treated), followed at the 3-prime end by a 3-prime copy of the AAV-ITR.
In another embodiment, the artificial AAV vector, which may include either type of expression cassette, is a single stranded vector. The single stranded vector includes a single stranded DNA segment including a 5-prime copy of the inverted terminal repeat (AAV-ITR) from the adeno-associated virus genome, followed by an expression cassette for a gene or gene-suppressing agent (whose identity depends upon the neurological disorder to be treated), followed at the 3-prime end by a 3-prime copy of the AAV-ITR. Optionally and preferably, the entire DNA sequence including either type of expression cassette is repeated in reverse complement order, so that the DNA sequence includes the 5-prime AAV-ITR, the expression cassette, an internal AAV-ITR, the reverse complement of the expression cassette, and the 3-prime AAV-ITR. The 3-prime AAV-ITR is the reverse complement of the 5-prime AAV-ITR (as illustrated, for example, in Example 1 herein), and either a 3-prime or 5-prime AAV-ITR can be used as the internal AAV-ITR. The resulting “self-complementary” artificial AAV vector is preferred because it may produce more effective transfection of neurons by the DNA. See, for example, Fu et al., Molecular Therapy 8:911-917 (2003).
It will be appreciated by those skilled in the art that the embodiment of a double-stranded artificial AAV vector and the embodiment of a single-stranded self-complementary artificial AAV vector differ only in that the single stranded self-complementary vector has a single, single-stranded AAV-ITR joining the complementary strands of the expression cassette (covalently joining the 3-prime end of one strand to the 5-prime end of the complementary strand, as shown schematically in FIG. 3b) so that the entire artificial AAV vector is one single DNA strand “folded back” on itself with hydrogen bonds between the complementary strands of the expression cassette. In the case of the double stranded artificial AAV vector, there are double-stranded AAV-ITRs at the 5-prime end and the 3-prime end of the expression cassette with no covalent bond joining strands at either end (as illustrated schematically in FIG. 3c).
An exemplary method for preparing a double-stranded artificial AAV vector is disclosed. The method includes the steps of: assembling the 5-prime AAV-ITR, expression cassette, and 3-prime AAV-ITR in any suitable DNA plasmid using standard DNA cloning methods; liberating the 5-prime AAV-ITR, expression cassette, and 3-prime AAV-ITR from the plasmid by digesting the plasmid with a restriction enzyme that cuts the DNA at a site just 5-prime to the 5-prime AAV-ITR and just 3-prime to the 3-prime AAV-ITR; and purifying the linear DNA fragment consisting of the 5-prime AAV-ITR, expression cassette, and 3-prime AAV-ITR using standard methods. Optionally, the resulting linear double-stranded artificial AAV vector may be further processed by a thermal treatment step including, for example, heating the purified linear DNA fragment (e.g., heating to 65° C. or higher for 10 minutes or more), followed by cooling (e.g., allowing the DNA fragment to cool slowly to room temperature over a period of 10 minutes or more). These heating and cooling steps can allow the AAV ITRs to assume a secondary structure, conducive to long-term gene expression from this double-stranded artificial AAV vector, as illustrated schematically in FIG. 3d. 
Exemplary methods for preparing a single-stranded DNA as described herein above are also disclosed. One method includes the steps of: assembling the 5-prime AAV-ITR, expression cassette, and 3-prime AAV-ITR in any suitable DNA plasmid using standard DNA cloning methods; generating a single-stranded RNA transcript of the desired single-stranded DNA from the DNA plasmid using standard in vitro transcription methods; generating single-stranded DNA from the RNA transcript by reverse transcription using standard reverse transcription reaction methods; removing the RNA transcript from the reaction products by digestion of the RNA using RNase enzyme; and purifying the resulting single-stranded DNA product from the reaction products by standard DNA purification methods, such as gel purification or column affinity methods.
Another method includes the steps of: assembling the 5-prime AAV-ITR, expression cassette, and 3-prime AAV-ITR in any suitable DNA plasmid using standard DNA cloning methods; linearizing the circular plasmid by digesting the plasmid with a restriction enzyme that cuts the DNA at a single, known location in the plasmid sequence just 5-prime to the 5-prime AAV-ITR; chemically conjugating an affinity tag (e.g., a biotin molecule) to the 5-prime ends of each strand of the linearized plasmid; cutting the DNA sequence with a restriction enzyme that cuts the DNA at a second single, known location in the plasmid sequence just 3-prime to the 3-prime AAV-ITR, such that the restriction digest results in two linear double-stranded DNA segments of different sizes; separating the populations of DNA molecules by size using any suitable size separation method (e.g., column filtration or gel electrophoresis) and recovering the desired double-stranded DNA; and melting the DNA to separate its two complementary strands into two single strands and passing the mixture through an affinity column for the tag (e.g., a streptavidin affinity column when a biotin molecule is used as the affinity tag) such that the strand which was tagged in step is captured on the column while the non-tagged single-strand flows through as the desired final product. This method can be advantageous for not involving any DNA or RNA polymerization steps that might introduce sequence errors in the final product.
In the case of a self-complementary AAV, the method includes the steps of: assembling the 5-prime AAV-ITR, expression cassette, internal AAV-ITR, reverse complement of the same expression cassette, and 3-prime AAV-ITR into any suitable DNA plasmid using standard DNA cloning methods; linearizing the circular plasmid by digesting the plasmid with restriction enzymes that cut out the desired DNA sequence (from the 5-prime AAV-ITR through the 3-prime AAV-ITR); recovering the desired DNA sequence from step 2 by size using any suitable size separation method; melting this double-stranded DNA to separate its two complementary strands into two single strands; and lowering the temperature (preferably slowly) of the melted DNA to allow the single strands to self-anneal into a hairpin form. All of the resulting single strands (“sense” or “anti-sense” strand) would be useful as the final product, since either strand would contain a copy of the desired expression cassette in a 5-prime to 3-prime orientation.
Compositions
For embodiments in which the composition is delivered across the blood-brain barrier, the composition includes, for example, a liposome as described, for example, in U.S. Pat. No. 6,372,250 (Pardridge), and a pharmaceutically acceptable carrier. Preferably the liposome is a receptor-specific liposome, wherein the receptor-specific liposome includes: a liposome having an exterior surface and an internal compartment; an artificial adeno-associated virus (AAV) vector located within the internal compartment of the liposome; one or more blood-brain barrier and brain cell membrane targeting agents; and one or more conjugation agents (e.g., polyethylene glycol (PEG) strands), wherein each targeting agent is connected to the exterior surface of the liposome via at least one of the conjugation agents. Receptor-specific liposomes including an artificial adeno-associated virus (AAV) vector located within the internal compartment of the liposome can be prepared by the general methods described in U.S. Pat. No. 6,372,250 (Pardridge), except that the artificial adeno-associated virus (AAV) vector is used instead of the plasmid DNA.
Liposomes as described herein can deliver biologically active agents across the blood-brain barrier, followed by expression in the brain. Liposomes and nanoparticles are exemplary forms of nanocontainers that are commonly used for encapsulation of drugs. The liposomes preferably have diameters of less than 200 nanometers. Liposomes having diameters of between 50 and 150 nanometers are preferred. Especially preferred are liposomes or other nanocontainers having external diameters of about 80 nanometers. Suitable types of liposomes are made with neutral phospholipids such as 1-palmitoyl-2-oleoyl-sn-glycerol-3-phosphocholine (POPC), diphosphatidyl phosphocholine, distearoylphosphatidylethanolamine (DSPE), or cholesterol, along with a small amount (1%) of cationic lipid, such as didodecyldimethylammonium bromide (DDAB) to stabilize the DNA within the liposome.
Although the invention has been described using liposomes as the preferred nanocontainer, it will be recognized by those skilled in the art that other nanocontainers may be used. For example, the liposome can be replaced with a nanoparticle or any other molecular nanocontainer with a diameter <200 nm that can encapsulate the DNA and protect the nucleic acid from nucleases while the formulation is still in the blood or in transit from the blood to the intracellular compartment of the target cell. Also, instead of using conjugation agents such as PEG strands, one or more other polymeric substances, such as sphingomylein, can be attached to the surface of the liposome or nanocontainer and serve the dual purpose of providing a scaffold for conjugation of the “transportable peptide” and for delaying the removal of the formulation from blood and optimizing the plasma pharmacokinetics. Further, the present invention contemplates delivery of DNA to any group of cells or organs which have specific target receptors. The liposomes may be used to deliver DNA to organs, such as liver, lung and spleen.
The liposomes may be combined with any suitable pharmaceutical carrier for intravenous administration. Intravenous administration of the composition is the preferred route since it is the least invasive. Other routes of administration are possible, if desired. Suitable pharmaceutically acceptable carriers include saline, Tris buffer, phosphate buffer, or any other aqueous solution. An appropriate dosage can be established by procedures well known to those of ordinary skill in the art.
Those of skill in the art are familiar with the principles and procedures discussed in widely known and available sources as Remington's Pharmaceutical Science (17th Ed., Mack Publishing Co., Easton, Pa., 1985) and Goodman and Gilman's The Pharmaceutical Basis of Therapeutics (8th Ed., Pergamon Press, Elmsford, N.Y., 1990).
In a preferred embodiment of the present invention, the compositions or precursors or derivatives thereof are formulated in accordance with standard procedure as a pharmaceutical composition adapted for delivered administration to human beings and other mammals. Typically, compositions for intravenous administration are solutions in sterile isotonic aqueous buffer.
Where necessary, the composition may also include a solubilizing agent and a local anesthetic to ameliorate any pain at the site of the injection. Generally, the ingredients are supplied either separately or mixed together in unit dosage form, for example, as a dry lyophilized powder or water free concentrate in a hermetically sealed container such as an ampule or sachette indicating the quantity of active agent. Where the composition is to be administered by infusion, it can be dispensed with an infusion bottle containing sterile pharmaceutical grade water or saline. Where the composition is administered by injection, an ampule of sterile water for injection or saline can be provided so that the ingredients may be mixed prior to administration.
In cases other than intravenous administration, the composition can contain minor amounts of wetting or emulsifying agents, or pH buffering agents. The composition can be a liquid solution, suspension, emulsion, gel, polymer, or sustained release formulation. The composition can be formulated with traditional binders and carriers, as would be known in the art. Formulations can include standard carriers such as pharmaceutical grades of mannitol, lactose, starch, magnesium stearate, sodium saccharide, cellulose, magnesium carbonate, etc., inert carriers having well established functionality in the manufacture of pharmaceuticals. Various delivery systems are known and can be used to administer a composition of the present invention including encapsulation in liposomes, microparticles, microcapsules and the like.
In yet another preferred embodiment, compositions can be formulated as neutral or salt forms. Pharmaceutically acceptable salts include those formed with free amino groups such as those derived from hydrochloric, phosphoric, acetic, oxalic, tartaric acids and the like, and those formed with free carboxyl groups such as those derived from sodium, potassium, ammonium, calcium, ferric hydroxides, isopropylamine, thriethylamine, 2-ethylamino ethanol, histidine, procaine or similar.
The amount of a composition of the present invention which will be effective in the treatment of a particular disorder or condition will depend on the nature of the disorder or condition, and can be determined by standard clinical techniques, well established in the administration of compositions. The precise dose to be employed in the formulation will also depend on the route of administration, and the seriousness of the disease or disorder, and should be decided according to the judgment of the practitioner and the patient's needs. Suitable dose ranges for intracranial administration are generally about 103 to 1015 infectious units of viral vector per microliter delivered in 1 to 3000 microliters of single injection volume. Addition amounts of infections units of vector per micro liter would generally contain about 104, 105, 106, 107, 108, 109, 1010, 1011, 1012, 1013, 1014 infectious units of viral vector delivered in about 10, 50, 100, 200, 500, 1000, or 2000 microliters. Appropriate dosage may be extrapolated from dose-responsive curves derived from in vitro or in vivo test systems.
Unless defined otherwise, the scientific and technological terms and nomenclature used herein have the same meaning as commonly understood by a person of ordinary skill to which this invention pertains. Generally, the procedures for cell cultures, infection, molecular biology methods and the like are common methods used in the art. Such standard techniques can be found in reference manuals such as for example Sambrook et al. (1989, Molecular Cloning—A Laboratory Manual, Cold Spring Harbor. Laboratories) and Ausubel et al. (1994, Current Protocols in Molecular Biology, Wiley, New York).
To summarize, the present invention provides methods to deliver small interfering RNA vectors to the human central nervous system, and thus treat memory loss in normal human brains and neurodegenerative diseases by reducing the production of a pathogenic protein within neurons.
The present invention is illustrated by the following examples. It is to be understood that the particular examples, materials, amounts, and procedures are to be interpreted broadly in accordance with the scope and spirit of the invention as set forth herein.
EXAMPLES
Example 1
Construction of a Small Interfering RNA Targeting Human Ataxin1 mRNA
As an example of the embodiments of the invention, a small interfering RNA that targets the mRNA for human ataxin1 was made. This small interfering RNA reduces the amount of mRNA for human ataxin1 in human cells, in cell cultures. As a therapy for Spinocerebellar Ataxia Type 1 (SCA1), this same small interfering RNA or a similar small interfering RNA will be delivered to the cells of the cerebellum in the patient's brain, using implanted access ports and catheters. The result will be a reduction in the amount of ataxin1 protein in these cells, thereby slowing or arresting the progression of the patient's SCA1 disease.
The small interfering RNA against human ataxin1 was been constructed from the nucleotide sequence for human ataxin1. The sequence from human ataxin 1 was retrieved from the publicly-accessible nucleotide database provided by NCBI, retrievable as NCBI accession number NM—000332 (SEQ ID NO:15). A portion of the human mRNA sequence for ataxin1 was identified as a potential site for small interfering RNA cleavage and also predicted to be single-stranded by MFOLD analysis. In accession NM—000332 (SEQ ID NO:15), three pairs of anti-ataxin1 siRNA targets were constructed:







1. Anti-ataxin1 siRNA targeting the mRNA


sequence at sites numbered 945 through 965:


SEQ ID NO: 1


5′ - AACCAAGAGCGGAGCAACGAA - 3′


SEQ ID NO: 2


3′ - GGTTCTCGCCTCGTTGCTTAA - 5′


 


2. Anti-ataxin1 siRNA targeting the mRNA


sequence at sites numbered 1671 - through 1691:


SEQ ID NO: 3


5′ - AACCAAGAGCGGAGCAACGAA - 3′


SEQ ID NO: 4


3′ - GGTTCTCGCCTCGTTGCTTAA - 5′


 


3. Anti-ataxin1 siRNA targeting the mRNA


sequence at sites numbered 2750 - through 2770:


SEQ ID NO: 5


5′ - AACCAGTACGTCCACATTTCC - 3′


SEQ ID NO: 6


3′ - GGTCATGCAGGTGTAAAGGAA - 5′






A series of six deoxyoligonucleotide fragments were designed, ordered and purchased from the MWG Biotech, Inc., custom oligonucleotide synthesis service to provide the six fragments making up the three target sites. Additionally, these oligonucletides were constructed to include an 8 base sequence complementary to the 5′ end of the T7 promoter primer included in an siRNA construction kit (Ambion, Inc. catalog number 1620). Each specific oligonucleotide was annealed to the supplied T7 promoter primer, and filled-in with Klenow fragment to generate a full-length DNA template for transcription into RNA. Two in vitro transcribed RNAs (one the antisense to the other) were generated by in vitro transcription reactions then hybridized to each other to make double-stranded RNA. The double-stranded RNA product was treated with DNase (to remove the DNA transcription templates) and RNase (to polish the ends of the double-stranded RNA), and column purified to provide the three siRNAs that were delivered and tested in cells.
Example 2
Delivery of a Small Interfering RNA Targeting Human Ataxin1 mRNA
The constructed siRNA molecules 1-3 described in Example 1 were transfected into HEK293 cells. The RNA produced by the transfected cells was harvested and assayed to measure the amount of human ataxin1 mRNA.
FIG. 1 shows the results of a quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) assay for the amount of ataxin1 messenger RNA (mRNA) per microgram of total RNA from cultures of HEK293H cells. Four cell populations were assayed. The first were 293H cells that had been transiently transfected with siRNA against GAPDH, a “housekeeping gene” with no known relationship to ataxin1 mRNA expression. (The siRNA against GAPDH was supplied as a standard control by Ambion, Inc., in their commercially-available kit for making and testing siRNA). The second were 293H cells that had been transiently transfected with siRNA against ataxin1 mRNA at location 1671 in the ataxin1 mRNA sequence. The third were 293H cells transiently transfected with a plasmid containing a ribozyme against ataxin1 mRNA (which cleaves ataxin1 mRNA at position 1364 in the ataxin1 mRNA sequence). The fourth were 293H cells transiently transfected with siRNA against ataxin1 mRNA at location 0945. All cell populations were harvested concurrently for total cellular RNA, at a time point 48 hours after transfection.
On the gels pictured, the amplified DNA products of the RT-PCR reaction were separated by molecular size, using gel electrophoresis, and are visible as bands of varying intensity. Each cell population described was assayed using a series of parallel reactions, shown as a set of lanes at the top or bottom of each gel. Each set of lanes contains two bands per lane. The top band is the DNA product amplified from a known quantity of DNA added to the reaction to compete with the endogenous cDNA reverse transcribed from the cellular mRNA. If the bands in a given lane are of the same intensity, then the amount of cellular mRNA in the original cell sample can be inferred to be equivalent to the amount of known quantity of DNA added to the reaction tube. From left to right across the lanes, the amount of known DNA standard added was decreased, in the picogram amounts shown. The assay is interpreted by looking for the set of lanes for which the intensity of the bands “crosses over” from being brightest for the DNA standard, to being brightest for the cellular product below it, indicating that the amount of DNA standard is now lower than the amount of cellular mRNA.
On the gel shown in FIG. 1, the top set of lanes is from the cells transfected with the ribozyme against ataxin1 mRNA. The comparison of the bands from this cellular sample to the bands from the DNA standards indicates that the amount of ataxin1 mRNA in these cells is between 0.505 and 0.303 picograms per microgram of total cellular RNA. The bottom set of lanes is from the cells transfected with siRNA against ataxin1 at position 0945. Analysis of these lanes indicates that the amount of ataxin1 mRNA in these cells is between 0.303 and 0.202 picograms per microgram of total cellular RNA.
On the gel shown in FIG. 2, the top set of lanes is from the cells transfected with a control siRNA against GAPDH. Analysis of these lanes indicates that the amount of ataxin1 mRNA in these cells is between 0.711 and 0.400 picograms per microgram of total cellular RNA. Finally, the bottom set of lanes is from cells transfected with another siRNA against ataxin1, at position 1671. These lanes indicate that the amount of ataxin1 mRNA in these cells is between 0.404 and 0.303 picograms per microgram of total cellular RNA.
In summary, the results of this particular analysis were:












Amount of ataxin1 mRNA (picograms per



microgram total cellular RNA)












Upper
Midpoint


Treatment
Lower bound
bound
Estimate





Control (GAPDH)
0.400
0.711
0.555


Ribozyme (A1364A) 
0.303
0.505
0.404


siRNA (AT1671)
0.303
0.404
0.353


SEQ ID Nos: 3 and 4





siRNA (AT0945)
0.202
0.303
0.252


SEQ ID Nos: 1 and 2









These data indicate that both the AT1671 and AT0945 siRNA against ataxin1 were effective at reducing the amount of ataxin1 mRNA in these cells within 48 hours after transfection, and that the siRNA were more effective at the reduction of ataxin1 mRNA than was this anti-ataxin1 ribozyme.
It should be noted that the exemplified method for constructing the small interfering RNA to be used as the therapeutic agents in the invention (that is, assembly from oligonucleotides using in vitro transcription and hybridization) is only one possible means for making the therapeutic small interfering RNA. Other larger scale, more efficient methods for manufacturing small interfering RNA may be used to produce the clinical grade and clinical quantities used for treating human patients, without altering the essence of the invention or departing from the spirit and scope of this invention, as set forth in the appended claims.
Example 3
Construction of Small, Interfering RNA Viral Vectors
A selectable reporter plasmid, pAAV-U6-Tracer for cloning siRNA was constructed. (See FIG. 3). The plasmid pAAV-U6-Tracer was constructed to contain the inverted terminal repeats (ITR) of adeno-associated virus, flanking the U6 RNA polymerase III promoter from pSilencer (Ambion), and the EF1a promoter, green fluorescence protein, Zeocinr resistance, and SV40 poly A from pTracer (Invitrogen). The gene segments are cloned as shown in FIG. 3. Oligonucleotides for expressing siRNA are cloned into the multiple cloning region just downstream in the 3′ direction from the U6 RNA polymerase III promoter.
HEK293 Cells are cotransfected with pAAV-siRNA, pHelper, and pAAV-RC to make viral producer cells, where the pAAV-RC and pHelper plasmids are part of the three plasmid AAV production system Avigen, Inc.). The producer 293 cells are grown in culture and are used to isolate recombinant viruses which is used to transfect cells for assessment of treatment effect, such as: HeLa Cells, DAOY cells, and SK-N-SH cells.
Example 4
Treatment of Memory Dysfunction Using RNA Interference Targeting Beta-Amyloid Cleaving Enzyme Type 1 (BACE1)
One aspect of the invention provides a therapy for Alzheimer's disease. Another aspect of the invention provides a therapy for memory dysfunction. The latter therapy has been tested in normal, aged mice. This therapy uses a viral vector that encodes for a siRNA sequence that, upon uptake by a neuronal cell, reduces the amount of mRNA for beta-amyloid cleaving enzyme type 1 (BACE1) produced in that neuronal cell. Reducing the amount of BACE1 mRNA in cells results in a reduction of the amount of the enzyme produced, and subsequently the amount of beta-amyloid fragments cleaved from the amyloid-precursor protein (APP) by the BACE1 enzyme. Reduction in the amount of beta-amyloid fragments in the brain is the biological mechanism by which memory dysfunction is treated by this therapy.
The overall steps involved in this work include (1) in vitro screening of candidate anti-BACE1 siRNA sequences for efficacy, (2) construction of a viral vector for in vivo delivery of DNA encoding for the anti-BACE1 siRNA to the mammalian brain, (3) neurosurgical administration of the vector to the mice, (4) testing of the behavior of the mice to assess the effect of the treatment, and (5) examination of the brain tissue of the mice to assess the effect of the treatment. Steps 1 and 2 are described in this Example in detail below, and steps 3, 4, and 5 are described in Example 5.
(1) Screening of Anti-BACE1 siRNA Sequences for In Vitro Efficacy
Identification of candidate anti-BACE1 siRNA sequences: In order to identify an siRNA sequence that is effective at reducing the expression of BACE1 mRNA in neuronal cells, analysis of the human and mouse cDNA sequences for the BACE1 gene available in the Genbank database (National Center for Biotechnology Information, accession numbers NM—012104, NM—138971, NM—138972, and NM—138973 for human, and NM—011792 for mouse) was performed. The analysis consisted of identifying sections of the cDNA sequence beginning with two successive adenine nucleotides (AA) or with a cytosine and adenine (CA), and comprising those two nucleotides plus the nineteen successive nucleotides. These candidate sequences were tested for possible partial matches to other sequences in other genes, using the BLAST software program provided by the National Center for Biotechnology Information website and sequences with a high amount of partial matching to other genes (e.g., a match of more than 15 out of the 19 successive nucleotides following the AA or CA nucleotides) were eliminated from further consideration. Candidate sequences with an extreme percentage of guanine or cytosine (G or C) nucleotides in the sequence (e.g., greater than 65% or less than 35% of the 19 successive nucleotides were G or C rather than A or T) were also eliminated from consideration. From the remaining candidates, the following were selected for laboratory screening:
Anti-BACE1 siRNA Candidates and Corresponding In Vitro Suppression of BACE1 Expression





















Starting 










position










within mouse










BACE1 cDNA










(Genbank

Method for production





Seq. ID


Accession
DNA sequence corresponding
of siRNA for in vitro
Mean

N


No
Item
Name
NM_011792)
to the therapeutic siRNA
screening
%*
SD
trials























24
1
MB0803
0803
AAGGGTGTGTATGTGCCCTAC
in vitro
57.0
1.4
2







transcription





 


25
2
MB1663
1663
AATTGGCTTTGCTGTCAGCGC
in vitro
42.0
24.0
2







transcription





 


26
3
MB1749
1749
AAGACTGTGGCTACAACATTC
in vitro
96.5
0.7
2







transcription





 


27
4
MB3249
3249
AAGGCTGCCTGGAGAAAGGAT
in vitro
0.0
11.3
2







transcription





 


28
5
DhMB0918
0916
CaCTGAATCGGACAAGTTCTT
chemical synthesis
78.7
24.8
3


 


29
6
DhMB1131
1129
CaTGATCATTGGTGGTATCGA
chemical synthesis
85.0
10.4
3


 


30
7
DhMB1233
1231
AaTCAATGGTCAAGATCTCAA
chemical synthesis
81.7
13.7
3


 


31
8
DhMB1509
1507
CaTCCTTCCTCAGCAATACCT
chemical synthesis
57.3
39.3
3


 


32
9
SEC0683
0683
CAGACGCTCAACATCCTGGTG
expression cassette
54.3
19.0
4


 


33
10
SEC1722
1722
AAGGTCCGTTTGTTACGGCAG
expression cassette
50.3
31.6
4


 


34
11
SEC2163
2163
AATATCCTTAGACACCACAAA
expression cassette
47.5
19.2
4


 


35
12
SEC2466
2466
AAACAAGAACCTATGCGATGC
expression cassette
41.5
33.3
4


 


36
13
SEC2473
2473
AACCTATGCGATGCGAATGTT
expression cassette
61.0
18.6
4





*Percent suppression of co-transfected BACE1 in Neuro2a cell cultures.






The set screened in the laboratory were selected to include candidates from a wide range of positions within the cDNA of the mouse BACE1 sequence. For purposes of testing this therapy in mice, it was essential that the siRNA sequence be effective at suppressing the native mouse BACE1 enzyme in the mice. Therefore, priority was given to candidate siRNA sequences corresponding to mouse cDNA regardless of the amount of homology to human BACE1 cDNA. However, some of the candidate siRNA sequences correspond 100% to human as well as mouse BACE1 cDNA. For example, MB1749, targets a regions of BACE1 mRNA that is 100% identical across the human and mouse species, and thus constitutes a therapy component that is applicable to humans as well as mice.
Production of siRNA candidates for in vitro testing: Double-stranded RNA corresponding to the MB0803, MB1663, MB1749, or MB3249 siRNA candidates were made by in vitro transcription from custom DNA oligonucleotides and other reagents using the Ambion SilencerTM siRNA Construction Kit (Ambion, Inc., Austin, Tex.; catalog number 1620) following the procedure recommended by the manufacturer. The custom DNA oligonucleotides used to produce our specific siRNA were as follows. The siRNA target sequences are listed in capital letters, while other oligonucleotides for use in the in vitro transcription method are listed in lower case letters.














SEQ ID:



SEQ ID


Sense
siRNA
Sense oligonucleotide (DNA)
Antisense oligonucleotide (DNA)
antisense







60
MB0803
aaGTAGGGCACATACACACCCcctgtctc
AAGGGTGTGTATGTGCCCTACcctgtctc
61


62
MB1663
aaGCGCTGACAGCAAAGCCAAcctgtctc
AATTGGCTTTGCTGTCAGCGCcctgtctc
63


64
MB1749
aaGAATGTTGTAGCCACAGTCcctgtctc
AAGACTGTGGCTACAACATTCcctgtctc
65


66
MB3249
aaATCCTTTCTCCAGGCAGCCcctgtctc
AAGGCTGCCTGGAGAAAGGATcctgtctc
67









Chemically synthesized double-stranded RNA corresponding to the DhMB0918, DhMB1131, DhMB1233, and DhMB1509 siRNA candidates were ordered from Dharmacon, Inc. (Lafayette, Colo.). The sequences specified for the supplier to produce were as follows:














SEQ ID:






(to Sense



SEQ ID


Oligonucl.
siRNA
Sense oligonucleotide (DNA)
Antisense oligonucleotide (DNA)
antisense







68
DhMB0918
CUGAAUCGGACAAGUUCUUdTdT
AAGAACUUGUCCGAUUCAGdTdT
69


70
DhMB1131
UGAUCAUUGGUGGUAUCGAdTdT
UCGAUACCACCAAUGAUCAdTdT
71


72
DhMB1233
UCAAUGGUCAAGAUCUCAAdTdT
UUGAGAUCUUGACCAUUGAdTdT
73


74
DhMB1509
UCCUUCCUCAGCAAUACCUdTdT
AGGUAUUGCUGAGGAAGGAdTdT
75









DNA expression cassettes were made from which cells transcribe RNA that forms a hairpin corresponding to the SEC0683, SEC1722, SEC2163, SEC2466, or SEC2473 siRNA candidates by polymerase chain reaction, using custom DNA oligonucleotides plus reagents from the Ambion SilencerTM Express siRNA Expression Cassette Kit (Ambion, Inc., Austin, Tex.; catalog number 1682) following the procedure recommended by the manufacturer. The custom DNA oligonucleotides used to produce specific siRNA expression cassettes were as follows. The siRNA target sequences are listed in capital letters, while other oligonucleotides needed for use in the expression cassette method are listed in lower case letters.













siRNA
strand
oligonucleotide (DNA)
SEQ ID:







SEC0683
sense
ggtgaagcttgACCAGGATGTTGAGCGTCTGccggtgtttcgtcctttccacaag
76



antisense
cggcgaagctttttccaaaaaaCAGACGCTCAACATCCTGGTGaagcttgacca
77


 


SEC1722
sense
cagctacacaaaCTGCCGTAACAAACGGACCcggtgtttcgtcctttccacaag
78



antisense
cggcgaagctttttccaaaaAAGGTCCGTTTGTTACGGCAGctacacaaactgc
79


 


SEC2163
sense
aaactacacaaaTTTGTGGTGTCTAAGGATAccggtgtttcgtcctttccacaag
80



antisense
cggcgaagctttttccaaaaAATATCCTTAGACACCACAAActacacaaatttg
81


 


SEC2466
sense
tgcctacacaaaGCATCGCATAGGTTCTTGTcggtgtttcgtcctttccacaag
82



antisense
cggcgaagctttttccaaaaAAACAAGAACCTATGCGATGCctacacaaagcat
83


 


SEC2473
sense
gttgaagcttgAACATTCGCATCGCATAGGccggtgtttcgtcctttccacaag
84



antisense
cggcgaagctttttccaaaaAACCTATGCGATGCGAATGTTgaagcttgaaca
85









In vitro application of the siRNA candidates to neuronal cell cultures: To assess the effectiveness of each anti-BACE1 siRNA candidate in suppressing BACE1 mRNA in vitro, mouse neuronal cells of the Neuro2a cell line (American Type Culture Collection, catalog number CCL-131) were cultured using the standard cell culture conditions for these cells. Upon reaching 50-70% confluence, the cells were co-transfected with one of the siRNA candidates, and with a plasmid containing the cDNA for mouse BACE and for green fluorescent protein (GFP). This plasmid, called pTracerBace1, was constructed for this purpose by cloning the full length open reading frame of murine BACE1 cDNA (Open Biosystems, Huntsville Ala., IMAGE mouse cDNA clone 6831622) into the pTracerTM-CMV2 plasmid (Invitrogen, Carlsbad Calif., #V885-20) downstream of the CMV promoter. The plasmid contains a second eukaryotic expression cassette encoding a fusion gene of green fluorescent protein and the Zeocin resistance marker (GFPzeo) whose expression is directed by the EF1α constitutive promoter (FIG. 6).
The cell transfection procedure and reagents used to conduct the in vitro testing varied as appropriate for the form (RNA or DNA) in which the siRNA candidate was applied. For transfection of cells with plasmid plus siRNA candidates produced by in vitro transcription (MB0803, MB1663, MB1749, MB3249) or by direct chemical synthesis (DhMB0918, DhMB1131, DhMB1233, DhMB1509), first a mixture of pTracerBace1 plasmid in Transit-Neural transfection reagent (Mirus, Inc. Madison, Wis.; catalog number 2144) was formed following the manufacturer's recommended procedures. Then, Transit-TKO transfection reagent (Mirus, Inc., catalog number 2154) was added dropwise to the Transit-Neural mixture, and incubated at room temperature for 10 minutes. Next, the siRNA was added to the mixture, incubated to allow the siRNA to form complexes with the Transit-TKO, then finally added dropwise to the cells. In all cases, the amount of pTracerBace1 plasmid per cell culture well was 1 microgram per well (of a six-well culture plate) across the various conditions, and the final concentration of siRNA per cell culture well is 25 nanoMolar.
For transfection of cells with plasmid plus siRNA candidates in the form of DNA (Silencer Expression Cassettes SEC0683, SEC1722, SEC2163, SEC2466, SEC2473) the method was similar, but SiPort-XP1 transfection reagent (Ambion, Inc., Austin, Tex.; catalog number 4506) was used for transfection of the cells with the double-stranded DNA PCR products constituting the expression cassettes. In these cases, SiPort-XP1 reagent was added dropwise to Opti-MEMO reduced-serum medium (Invitrogen, Carlsbad, Calif.; catalog number 22600), vortexed, and incubated at room temperature for 15 minutes following the procedure recommended by Ambion, Inc. Then, pTracerBace1 plasmid was added to one aliquot of the SiPort-XP1 mixture, and siRNA expression cassette DNA was added to a separate aliquot of SiPort-XP1 mixture. Each aliquot was incubated at room temperature for 15 minutes to allow the DNA molecules to complex with the SiPort-XP1 reagent, then the two mixtures were combined and added dropwise to cells. The amount of pTracerBace1 plasmid per cell culture well was 1 migrogram per well across the various conditions, and the amount of siRNA expression cassette DNA added per well was 500 nanograms per well.
Assay of the effect of siRNA candidates on BACE1 mRNA levels in cells: To determine the effect of siRNA candidate on BACE1 mRNA levels in cells, the cells were harvested 48 to 72 hours after transfection with the siRNA and pTracerBace1 plasmid, and total cellular RNA was recovered from the cell lysate using the Qiagen RNeasy Mini Kit (Qiagen, Inc., Valencia, Calif.; catalog number 74106). The RNA was treated with DNase during this isolation, to eliminate genomic and plasmid DNA from the samples. The RNA samples were reverse transcribed to cDNA using the StrataScript First Strand cDNA Synthesis Kit (Stratagene, Inc., La Jolla, Calif.; catalog number 200420) following the manufacturer's protocol, and using oligo-dT to prime the cDNA synthesis. Parallel samples included in the same protocol, but omitting the inclusion of the reverse transcriptase enzyme, were used to verify the lack of genomic or plasmid DNA carryover to the PCR analysis.
The cDNA samples obtained from the reverse transcription reactions were then used to conduct real-time quantitative PCR analysis of relative amounts of BACE1 cDNA, GAPDH cDNA, and GFP cDNA in the samples. The assays for the various cDNA species were conducted in parallel on aliquots of the same sample, divided just before the addition of the pertinent PCR primers and fluorescent substrates for the PCR reactions. All reactions were performed in parallel in a Rotor-Gene 3000 real-time PCR machine (Corbett Research, Inc., Sydney, Australia) using TaqMan Universal PCR Mix without Amperase UNG (Applied Biosystems Foster City, Calif.; catalog number 4324018) as the polymerase and nucleotide reagent. The PCR assay for mouse BACE1 was performed using the BACE1 Assay on Demand (Applied Biosystems; catalog number Mm00478664_ml). The assay for rodent GAPDH was the TaqMan® Rodent Gapdh Control Reagents (Applied Biosystems; catalog number 4308313). The assay for GFP (introduced into transfected cells by the pTracerBace1 plasmid) was the QuantiTect SYBR Green (Qiagen; catalog number 204143) and the following custom PCR primers: forward: 5′-TGGTGTTCAATGCTTTTCCC-3′ (SEQ ID NO: 55) and reverse: 5′-GCGTCTTGTAGTTCCCGTCA-3′ (SEQ ID NO: 56), produce an expected PCR product size of 128 basepairs.
To quantify the relative amounts of mRNA in various cell samples, a series of dilutions of cDNA from a sample of cells that was transfected with pTracerBace1 but not treated with any siRNA candidate was used to generate a standard curve relating PCR cycle threshold to cDNA quantity, ranging from 1 to 100 nanograms of mRNA per microliter of sample. Based on the standard curve for each mRNA target (BACE1, GAPDH, or GFP), the nanograms per microliter of mRNA of each gene product was obtained for each cell sample. Finally, the amount of BACE1 mRNA in the cell sample was normalized to the amount of GFP mRNA in the same sample. From these normalized amounts of BACE1 mRNA, the percentage reduction in BACE1 mRNA resulting from a given siRNA treatment relative to the untreated cells was calculated.
The cell transfections and quantitative real-time RT-PCR assays for BACE1 mRNA levels relative to GFP mRNA levels in transfected Neuro2a cells were repeated independently by at least two persons. The resulting percentage of BACE1 mRNA suppression for each siRNA candidate, averaged over the independent assays, was determined.
To further confirm the effectiveness of MB1749 at suppressing BACE1 expression, MB1749 siRNA or a scrambled control siRNA was co-transfected into HEK293 cells along with a variant of pTracer-BACE1 plasmid to which a myc epitope tag had been added at the carboxyl end of the BACE1 protein expression cassette (FIG. 6). A western blot of protein harvested from these cells 48 hours later showed substantial suppression of the myc-tagged BACE1 protein in cells transfected with the MB1749 siRNA compared to cells co-transfected with the scrambled siRNA or transfected with the pTracer-BACE1-myc plasmid alone (FIG. 7).
(2) Development of an AAV Vector Encoding for Anti-BACE1 siRNA:
To administer the MB1749 anti-BACE1 siRNA therapy to mice, an adeno-associated viral (AAV) vector containing DNA encoding for the MB1749 siRNA was chosen. AAV is known to transduce neuronal cells in vivo in the rodent brain following surgical injection into the brain tissue, and produce long-lasting expression of the delivered DNA within transduced neuronal cells. The expression of the MB1749 siRNA within transduced cells was driven by the mouse U6 RNA polymerase III promoter, provided by the pSilencerTM 1.0-U6 plasmid available from Ambion, Inc. (catalog number 7207). DNA was genetically engineered which encodes for a hairpin loop of RNA (consisting of the sequence for MB1749, a loop sequence, and the reverse complement of MB1749) (FIG. 6) into pSilencerTM between the ApaI and EcoRI restriction sites, using the following method.
Construction of the siRNA expression cassette using oligonucleotide condensation: In order to construct the DNA encoding for a hairpin loop of RNA corresponding to MB1749, the following four oligonucleotides were obtained from a synthesizing service:












Oligo name
SEQ ID NO:
DNA sequence







MB1749A
SEQ ID NO: 37
5′- GAAGACTGTGGCTACAACATTC -3′


 


MB1749B
SEQ ID NO: 38
5′- TTCAAGAGAGAATGTTGTAGCCACAGTCTTCTTTTTTG -3′


 


MB1749C
SEQ ID NO: 39
5′- TCTCTTGAAGAATGTTGTAGCCACAGTCTTCGGCC -3′


 


MB1749D
SEQ ID NO: 40
5′- AATTCAAAAAAGAAGACTGTGGCTACAACATTC -3′









In the above table, the portions of the oligonucleotide sequences that correspond to the effective siRNA sequence against BACE1 are underlined. Note that the reverse complement for oligonucleotide A is found within the sequence for oligonucleotide C, and all but the first four bases of oligonucleotide D is the reverse complement of the 3′ end of oligonucleotide B. Thus, A and C are largely complementary to one another, and B and D are largely complementary to one another.
To construct the double-stranded DNA insert to be cloned into pSilencerTM 1.0-U6 to make pMB1749 plasmid, the four oligonucleotides were suspended in water to a concentration of micromolar, then their ends were phosphorylated using T4 Polynucleotide Kinase enzyme. Next, in one tube, oligo MB1749A was mixed with oligo MB1749C, and in another tube, oligo MB1749B was mixed with oligo MB1749D. The mixtures were heated to 65° C. for 5 minutes then allowed to cool slowly to room temperature, to cause these complementary oligonucleotides to anneal into double-stranded form, with single-stranded overhangs. Next, a three-component ligation reaction was conducted by mixing oligosA/C and oligos B/D with pSilencerTM 1.0-U6 that had been linearized with ApaI and EcoRI restriction enzyme digestion, using standard molecular biology methods. The resulting ligation products were cloned into bacteria, and colonies screened to identify the desired plasmid product, which consists of the following construct inserted between the ApaI and EcoRI restrictions sites in pSilencerTM 1.0-U6 (SEQ ID NOs: 57 and 58, respectively):




This strategy of assembling four oligonucleotides, rather than a single sense and antisense pair, was used to efficiently clone the DNA coding for the MB1749 hairpin siRNA. Use of single sense and antisense strands (such as can be obtained by concatenating the sequence for MB1749A with MB1749B, making one longer sense strand oligonucleotide, and contatenating MB1749C and MB1749D, making one longer antisense strand) results in molecular strands that tend to form intramolecular hairpins, preventing annealing into a double-stranded DNA, and ligation into the plasmid.
Verification of BACE1 mRNA expression by the MB1749 plasmid: In order to verify that the pMB1749 plasmid, coding for a hairpin loop of RNA corresponding to MB1749, does in fact produce an siRNA that reduces the amount of BACE1 mRNA in cells, mouse Neuro2a neuronal cells were co-transfected with pTracerBace1 plasmid and pMB1749 plasmid, using the SiPort-XP1 transfection reagent as described above. After 48 hours, the total cellular RNA was harvested from these cells, and used to conduct a reverse transcription quantitative real-time PCR assay, as described above. The results showed 94% suppression in BACE1 mRNA compared to cells not treated with pMB1749. A second plasmid (pControl) containing a scrambled sequence (shRNA corresponding to 5′-TGACACAGCCGCTACTACATTG-3′, SEQ ID NO: 59) was constructed as a control, and confirmed not to suppress BACE1 mRNA expression in vitro.
Verification of BACE1 mRNA expression by the MB1749 viral vector: To obtain a supply of the viral vector for administration to the brains of mice in vivo, the pMB1749 plasmid was provided to GeneDetect, Ltd. (Auckland, New Zealand) for transfer of the U6 promoter, the MB1749 construct, and the RNA polymerase III termination sequence (consisting of 6 thymines in succession) into their plasmid containing AAV inverted terminal repeats and a green fluorescent protein reporter gene expressed from a chicken beta-actin enhancer and CMV promoter. The MB1749 expression cassette (U6 promoter, MB1749 construct, and termination sequence) was inserted following the 5′ inverted terminal repeat for AAV, and before the GFP expression cassette. The resulting AAV plasmid was then used by GeneDetect to produce AAV-anti-BACE1-MB1749. GeneDetect was also provided with another plasmid containing a scrambled sequence for MB1749, which can be verified in vitro not to be active at suppressing BACE1 mRNA expression and not homologous to any known gene in Genbank, for production of AAV-control vector. AAV-MB1749 viral particles with a chimeric AAV1/2 capsid were produced from this plasmid using an adenovirus-free method, and were provided at a titer of 1.2-1.4×1012 genomic particles per milliliter. Similarly, AAV-Control vector was made from the pControl plasmid, and provided at a titer of 3.8-4.1×1012 genomic particles per milliliter.
To verify in vitro that the resulting AAV-anti-BACE1-MB1749 vector, when used to infect cells, results in suppression of BACE1 mRNA, and the AAV-control vector does not, HEK293 cells were infected with AAV-MB1749 or AAV-Control, then 24 hours later transfected with pTracerBACE1. Infection of cells by the AAV was confirmed by observation of GFP expression. In two separate cell cultures, AAV-MB1749 resulted in a 72.8% and 57.6% (average, 65.2%) reduction in BACE1 mRNA 72 hours post-viral transduction, while AAV-control vector had no significant effect (16.2% and <0% reduction in two separate cultures).
Example 5
AAV-Mediated BACE1 Gene Silencing in the Hippocampus Improves Contextual Fear Conditioning in Aging Mice
The effect of reducing BACE1 levels in the hippocampus of aging, wildtype mice was determined following AAV-mediated siRNA delivery using the AAV vectors produced as described in Example 4. In this regard, behavioral freezing following contextual fear conditioning was used as an indicator of hippocampal function, as the acquisition and maintenance of a freezing response to a context previously paired with an unconditioned stimulus (foot shock) is dependent upon hippocampal function. Lesions of the dorsal hippocampus prevent the acquisition of contextual conditioning (Phillips, R. G. and LeDoux, J. E., Learn Mem., May-June (1994) 34-44) and post-training lesions attenuate contextual freezing (McNish, K. A., al., J. Neurosci., 17 (1997) 9353-9360).
It has been shown that single injections of AAV-mediated shRNA can result in persistent silencing of targeted gene expression in transduced regions of the rodent brain in vivo (Xia, H. et al., Nature Medicine, 10 (2004) 816-820). While reactive astrocytes have been shown to express BACE1 (Hartlage-Rubsamen, M., et al., Glia, 41 (2003) 169-179), the vast preponderance of BACE1 activity in the brain is in neurons (Zhao, J., et al., J. Biol. Chem., 271 (1996) 31407-31411). Accordingly, an AAV vector (with chimeric serotype 1/2) that preferentially transduces neurons almost to the exclusion of glia was used (Burger, C., et al., Mol. Ther., 10 (2004) 302-317). Overall steps in this work include (1) in vitro screening of candidate anti-BACE1 siRNA sequences for efficacy, and (2) construction of a viral vector for in vivo delivery of DNA encoding for the anti-BACE1 siRNA to the mammalian brain, as described in Example 4, and (3) neurosurgical administration of the vector to the mice, (4) testing of the behavior of the mice to assess the effect of the treatment, and (5) examination of the brain tissue of the mice to assess the effect of the treatment.
Step 3) Neurosurgical administration of the vector to the mice: Pilot injections (to confirm stereotactic coordinates): To verify correct anatomical targeting of the mouse hippocampus in this age and strain of mouse, and to verify expression from the AAV vector, three nine-month old wildtype C57BL/6 female mice were injected with 5 microliters of a standard AAV vector (at a concentration of approximately 2.3×1012 viral particles per milliliter) containing the GFP reporter gene (rAVE-GFP 1/2, GeneDetect, Auckland, New Zealand). The injections were at the following stereotactic coordinates, expressed in millimeters from bregma, with the incisor bar at −5 mm: AP −2.70, ML ±3.00, DV −2.25. (The details of the neurosurgical procedure used to perform the injections are further described below).
Thirteen days post-surgery, these mice were euthanized and transcardially perfused with saline followed by 4% paraformaldehyde to flush and fix their organ tissues. The brains were cut into 30 micron thick sections along the parasagittal planes, with serial sections collected from throughout the entire left and right hemispheres. These sections were numbered sequentially with the lower numbers assigned to the lateral edge of the hemisphere, and higher numbers to the more medial sections of the hemisphere. Approximate targeting of the AAV vector to the hippocampus of the mice using this method was confirmed by visual confirmation of green fluorescent protein expression in the hippocampus of these mice by fluorescence microscopy, and the stereotactic coordinates for use in the main study were refined to −2.3 mm AP, +/−2.0 mm ML, and 1.6 mm DV below dura.
Neurosurgical method: The details of the neurosurgical method for use in delivery of the therapy of the present invention to mice are as follows. After the induction of surgical anesthesia using isofluorene inhalation, the mouse is placed in the stereotaxic frame and its head is immobilized using the ear bars, incisor bar and anesthesia mask associated with the apparatus (MyNeuroLab, St. Louis, Mo.; BenchmarkTM Digital Stereotaxic). The patency of the mouse's airway is verified. The fur on the head is clipped, and betadyne is used to sanitize the scalp. After the depth of the mouse's anesthesia is verified (i.e., unresponsive to tail and paw pinch), a midline incision 1.0 to 1.5 cm in length is made in the skin over the skull in the saggital plane. The skin is manually retracted and membranous tissue covering the skull is scraped away with a sterile #11 scalpel blade. A Hamilton syringe (Hamilton Company, Reno, Nev.; Model 88011) is placed in the syringe holder of the stereotaxic frame, and the tip of the syringe needle is moved to the bregma point on the mouse's skull; (the intersection of the rostral, medial-lateral bone suture and the midline suture, identifiable by visual inspection). The needle is then positioned to the following stereotaxic coordinates on the left side of the skull: AP=−2.30 mm, ML=−2.00 mm. The corresponding point on the skull is noted visually through the surgical microscope. A dental drill with a sterile burr bit is used to erode a burr hole at this site through the skull bone. The syringe needle is again positioned at the bregma point, then moved to AP=−2.30 mm, ML=+2.00 mm on the right hemisphere of the skull. The site is noted visually, and a burr hole made at this site.
Once the burr holes are made, a Hamilton syringe is loaded with 5 microliters of AAV vector (AAV-antiBACE1-MB1749 or AAV-control at 1.3 to 3.9×1012 genomic particles per milliliter), positioned from bregma to AP −2.30, ML −2.00, then lowered until the tip of the needle pierces the dura membrane covering the brain. Next, the needle is lowered to 1.25 mm below dura and left in place for 2 minutes. Then, the 5.0 microliters of AAV solution is injected into the hippocampus via the Hamilton syringe at the rate of 0.333 microliters per minute using an automated syringe pump. At the conclusion of the 15-minute injection, the needle is left in place for 2 minutes. Finally, the needle is slowly withdrawn from the brain at the rate of about 1 mm per minute. Once the needle tip is clear of the dura, the injection to this site is complete. Injection to the site in the right hemisphere proceeds in the same manner. Following completion of both injections, the incision in the skin over the skull is approximated using forceps and the skin is closed with silk sutures. The skin is swabbed with alcohol and the mouse is removed from the stereotaxic device and placed in a clean recovery cage. Sterile saline (0.5 mL) is injected subcutaneously at a site on the back to aid in hydration, and diazepam (1-2 mg/kg) is administered to prevent the occurrence of seizures during recovery. Upon complete recovery from anesthesia, the animal is returned to standard housing.
Eleven-month old female C57B6/SJL wildtype mice were obtained from the University of Minnesota (nine mice, courtesy of Karen Hsiao-Ashe) and from Taconic Farms (six mice, Germantown, N.Y.). Mice were housed two or three mice per cage in a 12-hour light/dark cycle temperature-controlled environment with food and water available ad lib. At 12 months of age, each mouse received a single, bilateral injection of either AAV-MB1749 or AAV-Control into the hippocampus at (from bregma) −2.3 mm AP, +/−2.0 mm ML, and 1.6 mm DV below dura, while under anesthesia by isofluorene inhalation. A digital stereotactic headframe was used for precise targeting. At each injection site, 5 microliters of AAV vector was infused via Hamilton syringe and syringe pump at a rate of 0.333 microliters per minute. Following each 15-minute infusion, the syringe was left in place for an additional two minutes for pressure equalization and then removed from the brain over a period of two minutes. Upon recovery from anesthesia, the mouse was returned to its normal housing. Mice were randomly assigned to receive either the AAV-MB1749 or AAV-Control vector, with nearly equal numbers of mice from each supplier assigned to each experimental group.
Step 4) Testing of the behavior of the mice to assess the effect of the treatment: The contextual fear conditioning procedure is a well-established method in the published research literature, and it has been determined that this method provides a measurement for hippocampus-dependent brain functioning. The procedure is a behavioral test that is performed over two successive days. On the first day, the mouse receives training to associate a cage context and auditory cue with a mild electric foot shock. On the second day, the mouse is placed in the same cage context as the first day, but no shocks are administered; rather, the amount of movement (or conversely, behavioral “freezing”) of the mouse is observed and quantified by instrumentation. The mouse is returned to its home cage for an hour, then placed in a novel apparatus and again its amount of movement (or “freezing”) is quantified.
At 15, 16, 18, and 19 months of age, each mouse was tested using a two-day contextual fear conditioning protocol similar to that described by Dineley, et al., (J. Biol. Chem., 277 (2005) 22768-22780). On the first day (“training”), the mouse was placed in the fear conditioning apparatus (Coulbourn Instruments, Allentown Pa. #H10-11M-TC), and allowed to freely explore the chamber for 3 minutes. Next, repetitions of the following stimulus regimen were presented: an auditory cue (80 dB white noise) and visual cue (lighting of a white bulb positioned in the chamber wall) were presented for 20 seconds. During the final two seconds of the 20-second period, a 0.20 millivolt (0.5 mAmp) foot shock was administered to the mouse through the floor grid of the chamber. A 40-second interval elapsed before the next cue presentation. At 15 months of age, five repetitions of this regimen were presented; at 16, 18, and 19 months of age, two repetitions were presented. On the second day of each two-day protocol, 24 hours after “training,” the mouse was placed in the fear conditioning apparatus and its behavior was videotaped for five minutes. No cues or foot shocks were presented during this “test” period. One hour later, the light bulb and speaker were removed from the apparatus, and the apparatus was altered to have different wall appearance (color pattern versus bare metal), a different floor (smooth plastic versus wire grid), and a different scent (citrus versus no scent). The mouse was placed in this “novel” environment, and its behavior was videotaped for three minutes.
Contextual fear conditioning (a hippocampus-dependent function) was assessed by comparing motor “freezing” by the mice in the “test” compared to the “novel” environment. (Cued fear learning was not assessed). Freezing behavior was scored automatically by machine using the FreezeFrameTM video system (Actimetrics, Wilmette Ill.). This system computes frame-by-frame differences in the video image (at four frames per second), and is capable of detecting movements as small as 1 mm. Freezing “bouts” exceeding 1.0 second were scored as behavioral freezing; the amount of behavioral freezing per “training” period (prior to the first cue/shock presentation), per “test” period (five minute observation) and per “novel” period (three minute observation) were expressed as percent of total time spent freezing. The data for the mice receiving the AAV-MB1749 vector (n=7) and the mice receiving the AAV-Control vector (n=8) are shown in the table below. Contextual fear conditioning for each mouse was measured as the difference between the percent of time spent freezing in the “test” environment versus the “novel” environment, on the same measurement day. A repeated measures ANOVA of these difference scores shows significantly greater contextual fear conditioning in mice receiving the AAV-MB1749 vector (F (1.11)=8.57, p<0.015), and a marginally significant increase in contextual fear conditioning across both groups of mice over months (F (3.33)=2.35, p<0.09). The profile of difference scores across months did not differ by AAV treatment group (p=0.997 for F-test of interaction effect).
Percent Behavioral Freezing in Contextual Fear Conditioning Assay














Context
Age (mos)
AAV-MB1749
AAV-Control
p*



















Day 1: Training
15
1.1 %
0.6 %
ns



16
49.8
42.9
ns



18
72.1
47.6
0.061



19
66.8
52.8
ns


Day 2: Test
15
48.9
24.2
0.043



16
61.8
36.1
0.062



18
74.9
44.4
0.019



19
60.1
45.2
ns


Day 2: Novel context
15
2.3
4.1
ns



16
12.4
9.0
ns



18
10.6
3.4
ns



19
7.2
15.0
ns


Difference (Test-Novel)
15
46.6
20.2
0.016



16
49.3
27.0
0.053



18
64.3
41.0
0.059



19
52.9
30.2
0.093





*p values for t-tests comparing treatment groups






Further analyses of these data on a month-by-month basis indicate that the mice receiving AAV-MB1749 exhibited more freezing than the mice receiving AAV-Control in the “test” period at ages 15, 16, and 18 months, while there was no difference among the two groups of mice in the amount of freezing exhibited in the “novel” environment at any age (see Table immediately above). In addition, there is marginally significant evidence (p=0.0613) that the mice receiving AAV-MB1749 had better long-term recall of the context in which they had received the foot shocks, in that they exhibited more freezing (72.1%) than control mice (47.6%) during the “training” period at age 18 months (prior to the first presentation of the cues and shock at that age) though they had not been exposed to the apparatus for two months. The mice receiving the AAV-Control vector did not display this enhanced long-term recall. These data are consistent with the interpretation that mice receiving hippocampal injections of the AAV-MB1749 vector at twelve months of age displayed better hippocampal-dependent learning and recall at 15 months of age, with the enhancement persisting for at least three more months (through 18 months of age).
5) Examination of the brain tissue of the mice to assess the effect of the treatment: To verify that the administration of AAV-MB1749 to the mice resulted in suppression of BACE1 protein expression, the brains of the mice were harvested at termination when the mice were 19.5 months old, and analyzed by immunohistochemistry. One mouse that received AAV-Control was found dead in its cage at 18.5 months of age—efforts to preserve its brain for histological analysis were unsuccessful. A blinded pathologist's examination of this mouse found a lymphosarcoma of the mesenteric lymph node, a common finding in SJL mice over 12 months of age (Katz, J. D. and Bonavida, B., Bioessays, 11 (1998) 181-185). Mice were euthanized by Nembutal overdose, then transcardially perfused with 50 mL of wash solution (137 mM NaCl, 20 mM dextrose, 23 mM sucrose, 2 mM anhydrous CaCl2, and 1.6 mM anhydrous sodium cacodylate), followed by 100 mL of fixation solution (117 mM sucrose and 67 mM sodium cacodylate in 4% paraformaldehyde, pH 7.3). Brains were stored in 1.6 mM sodium cacodylate solution (pH 7.0) at 4 degrees C. until processing. All brains were then mounted in a single MultiBrainTM block (Neuroscience Associates [NSA], Knoxville Tenn.) and sectioned coronally (35 μM sections). Every fourth section throughout the hippocampus was stained for BACE1 by NSA using a polyclonal rabbit anti-BACE1 antibody (Calbiochem, San Diego Calif., #195111, 1:2000 dilution), visualized using peroxidase-conjugated secondary antibody (VectastainTM ABC Method, Vector Laboratories #PK-6101). Adjacent sections were used to identify regions of AAV transduction, by means of fluorescence microscopy for GFP protein expression. The extent of transduction of mouse brains by the AAV-MB1749 or AAV-Control vector did not differ across treatment groups or hemispheres, with GFP-expressing cells detectable in an average of 3.5 coronal sections (spanning 490 microns rostrocaudally). Example images of hippocampal regions transduced by the AAV vectors and BACE1 immunostaining of these regions are shown in FIG. 8.
To quantify the level of expression of BACE1 in the mouse brains, scans of the brain sections immunostained for BACE1 were digitized as 24-bit color images at a resolution of 2400 pixels per inch with an Epson 4870 scanner. These images were overlaid with fluorescence microscopy images of adjacent, corresponding brain sections to identify regions that expressed GFP from the AAV transgene. Regions of pixels encompassing GFP-expressing cells in the neuronal layers of the hippocampus were identified for each hemisphere of each mouse brain section in a series of seven slides spanning 875 microns of the rostral-caudal extent of the hippocampus surrounding the AAV injection sites. The staining intensity for BACE1 in each hemisphere of each section was measured by averaging the pixel intensity value of pixels in these regions (min 3, max 16, average 10 regions per measurement). For each hemisphere and tissue section, a comparable intensity measurement was made for non-GFP expressing cells in adjacent areas of the hippocampus. Although the staining variability across sections and mice was minimal (due to the MultiBrainTM method of processing), the staining intensity of non-GFP-expressing cells was subtracted pairwise from the staining intensity of GFP-expressing cells to control for background staining levels. An ANOVA of these difference scores showed that the amount of BACE1 protein expressed by GFP-positive cells in the hippocampus of mice receiving AAV-MB1749 injections was significantly reduced compared to mice receiving AAV-Control injections (F (1.45)=10.88, p=0.0019). When expressed as a percentage of background intensity, the pixel intensity of BACE1 stained GFP-positive cells in mice treated with AAV-MB1749 was 12.7%±2.1% fainter than the background staining (versus 4.5%±2.1% [mean±se] fainter in mice treated with AAV-Control). These results indicate that hippocampal injections of AAV-MB1749 resulted in reduced expression of BACE1 enzyme in the treated mice, consistent with persistent expression of the anti-BACE1 shRNA transgene.
Reduction in Abeta in AAV-MB1749 treated mice resulting from the action of the anti-BACE1 shRNA transgene was investigated by staining sections from all mouse brains for soluble Abeta and amyloid deposits. However, in these wildtype mice, levels of soluble Abeta were below detection limits throughout the brain in both treatment groups, and no amyloid deposits were detectable. Nevertheless, because BACE1 activity is required for the production of Abeta from APP (Cai, H., et al., Nat. Neurosci., 4 (2001) 233-234; Luo, Y., et al., Neurobiol. Dis., 14 (2003) 81-88), and because increased expression of beta-secretase in mouse brain results in increase steady-state levels of beta amyloid (Bodendorf, U., et al., J. Neurochem., 80 (2002) 799-806), our results showing reduced BACE1 expression in the AAV-MB1749 treated mice suggest that Abeta production and steady-state levels of Abeta in the hippocampal regions of these mice also were reduced.
In this experiment, whether or not reduced Abeta could be measured, the possibility would remain that the enhanced fear conditioning observed in the AAV-MB1749 treated mice was due to a direct effect of reduced BACE1 expression or reduction in some other product of BACE1 activity (Kitazume, S., et al., J. Biol. Chem., 280 (2005) 8589-8595) rather than an effect mediated by reduced Abeta production. It has been shown that BACE1 knock-out mice have an “anxious” behavioral phenotype that includes reduced exploratory behavior and timidity (Harrison, S. M., et al., Mol. Cell Neurosci., 24 (2003) 646-655). However, the fear conditioning effect observed in the AAV-MB1749 treated mice was contextual, and not a reflection of an overall increase in fearful behavior. No differences were seen between these mice and control mice in behavior in the apparatus at the start of training (prior to the first shock presentation) or at any time in the “novel” context (see table immediately above). Thus, these results are more consistent with a local effect on hippocampal functioning than with a more general effect of BACE1 reduction.
Because soluble Abeta can be synaptotoxic (Mucke, L., et al., J. Neurosci., 20 (2000) 4050-4058) and intracerebro-ventricular administration of oligomeric forms of beta amyloid into normal rats is sufficient to produce cognitive impairment (Cleary, J. P., et al., Nat. Neurosci., 8 (2005) 79-84), these results support a beneficial effect of Abeta reduction in the hippocampus on hippocampal-dependent functioning, however it is possible that the beneficial effect of BACE1 suppression was due to some other mechanism. Notably, the effect did not require treatment of the animals at a young age, but was obtained in older adult animals. In addition, the beneficial effect was obtained in normal, aging animals, and was not dependent upon an over-expression of APP. These findings support the significance of BACE1 as a treatment target not only for Alzheimer's disease, but also for other mild cognitive impairments associated with aging.
Example 6
AAV-Mediated BACE1 Gene Silencing in the Hippocampus as a Treatment for Alzheimer's Disease in a Transgenic Mouse Model of Alzheimer's Disease
The present invention can be validated for treatment of Alzheimer's disease by surgically injecting an AAV vector encoding for the MB1749 siRNA targeting murine BACE1 into the hippocampus of 12 month-old female Tg2576 mice, then assessing the mice for effects of the therapy at ages 15 months and beyond.
The Tg2576 mouse is an accepted animal model of Alzheimer's disease that overexpresses the human transgene for APP (Hsiao et al, 1996). The Tg2576 transgenic mouse line develops amyloid plaques containing beta-amyloid beginning at about 10 to 12 months of age (Gau et al, 2002). The plaques are particularly frequent in the cerebral cortex and hippocampus. They are readily detectable 15 months of age, and become more severe at 19 months of age and beyond (Kawarabayashi et al, 2001). Aged female Tg2576 mice deposit significantly more beta-amyloid in the brain than do aged male Tg2576 mice (Callahan et al, 2001). By 19 months of age, the Tg2576 mice exhibit behavioral and cognitive deficits on measures of balance, agility, and spatial memory (King and Arandash, 2002).
Experimental design for In Vivo Testing in Tg2576 Transgenic Mice Several heterozygous transgenic and age-matched wildtype controls from Tg2576 litters (obtained from Taconic Farms, Inc.) are injected with either AAV-antiBACE1-MB1749 or AAV-control at 12 months of age using the above procedure. Half of the mice receive bilateral injections of AAV-antiBACE1-MB1749, and the other half receive bilateral injections of AAV-control, in a 2×2 design:











Number of mice
Treatment Administered









Genotype:
AAV-anti-BACE1-MB1749
AAV-control





Tg2576 heterozygote
N
N


Wildtype
N
N





* N equals the number of mice used in the experiment.






Overall steps in this work will include (1) in vitro screening of candidate anti-BACE1 siRNA sequences for efficacy, and (2) construction of a viral vector for in vivo delivery of DNA encoding for the anti-BACE1 siRNA to the mammalian brain, as described in Example 4, and (3) neurosurgical administration of the vector to the mice as described in Example 5, (4) testing of the behavior of the mice to assess the effect of the treatment as described in Example 5, and (5) examination of the brain tissue of the mice to assess the effect of the treatment as described below.
Step 5) Histological analysis of the effects of anti-BACE1 siRNA treatment in the Tg2576 mouse brain tissue: Once the mice that have been treated with AAV-anti-Bace1-MB1749 or AAV-control have attained the age of 19 months, they will be euthanized and their brain tissue examined to determine the effect of the treatment on level of BACE1 protein in the treated regions of the hippocampus, and the effect of the treatment on the extent of beta-amyloid plaque formation in those regions. The treated regions will be identifiable based on the expression of green fluorescent protein in the neuronal cells. The level of BACE1 protein will be identifiable based on immunohistochemical staining using standard methods, with an anti-Bace1 primary antibody, and a peroxidase-conjugated secondary antibody for visualization.
In the treated animals (heterozygous Tg2576 or wildtype mice receiving AAV-anti-BACE1-MB1749), it is expected that the amount of BACE1 protein will be reduced in the regions expressing the GFP reporter gene, and that also in these regions in the heterozygous Tg2576 mice, there will be fewer beta-amyloid plaques.
All publications cited in the specification, both patent publications and non-patent publications, are indicative of the level of skill of those skilled in the art to which this invention pertains. All these publications are herein fully incorporated by reference to the same extent as if each individual publication were specifically and individually indicated as being incorporated by reference. Further, the hard copy of the sequence listing submitted herewith and the corresponding computer readable form are both incorporated herein by reference in their entireties.
Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the following claims.

## Claims

1. A method for improving memory or cognitive function in a subject diagnosed as having a disorder in which a diminished declarative memory is a symptom, comprising intracranially administering to the subject a therapeutically effective dose of a composition that decreases the expression of a beta amyloid cleaving enzyme type 1, or BACE1, in a cell of the nervous system of the subject, wherein the composition comprises a shRNA or a siRNA or a vector encoding said siRNA or said shRNA, wherein further said shRNA or said siRNA comprises a double-stranded portion 21 to 30 nucleotides long and wherein one strand of said double-stranded portion comprises 21 contiguous nucleotides encoded by SEQ ID NO: 26, 30, or 28, and wherein at least one attribute of said memory or cognitive function is improved.

2. The method of claim 1 wherein the composition is delivered to the subject by intracranial delivery through an intracranial access device.

3. The method of claim 2, further comprising the step of: implanting a pump outside the brain, the pump coupled to the proximal end of an intracranial catheter.

4. The method of claim 3 comprising operating the pump to deliver a predetermined dosage of the said shRNA or said siRNA or said vector encoding said siRNA or said shRNA from the pump through a discharge portion of the said intracranial catheter.

5. The method of claim 3 further comprising the step of periodically refreshing the pump with said composition.

6. The method of claim 3 wherein the pump is an infusion pump.

7. The method of claim 6 wherein the infusion pump is an electromechanical pump.

8. The method of claim 6 wherein the infusion pump is an osmotic pump.

9. The method of claim 1, wherein said composition is delivered to the nucleus basalis of Meynert or the cerebral cortex or the hippocampus.

10. The method of claim 1, wherein the composition comprises the vector encoding said siRNA or said shRNA.

11. The method of claim 10, wherein the vector is selected from the group consisting of adeno-associated virus, adenovirus, herpes simplex virus, lentivirus and a DNA plasmid.

12. A method of delivering a small interfering RNA across a blood-brain barrier for expression in the brain of a subject diagnosed as having or being at risk of developing disorders in which diminished declarative memory is a symptom comprising administering to a blood vessel directly supplying blood to the brain of the subject a composition comprising a liposome having an exterior surface and an internal compartment containing an artificial adeno-associated virus (AAV) encoding a shRNA comprising a double-stranded portion between 21 and 30 nucleotides long, wherein one strand of said double-stranded portion is encoded by SEQ ID NO: 26, 30, or 28.

13. The method of claim 12, wherein the artificial AAV vector is for delivery of a single stranded DNA encoding the shRNA, the artificial AAV vector comprising the single stranded DNA having AAV-ITRs at the 5-prime and 3-prime ends.

14. The method of claim 12, wherein the artificial AAV vector is for delivery of a single stranded DNA encoding the shRNA, the artificial AAV vector comprising, in 5-prime to 3-prime order: a 5-prime AAV-ITR; the single stranded DNA; an internal AAV-ITR; a reverse complement of the single stranded DNA; and a 3-prime AAV-ITR.

15. The method of claim 12, wherein the artificial AAV vector is for delivery of a linear, double stranded DNA encoding said shRNA, the artificial AAV vector comprising the linear, double stranded DNA having AAV-ITRs at the 5-prime and 3-prime ends of each strand, or wherein the artificial AAV vector is for delivery of a single stranded DNA encoding said shRNA, the artificial AAV vector comprising, in 5-prime to 3-prime order: a 5-prime AAV-ITR; DNA encoding one strand of said shRNA; an internal AAV-ITR; DNA encoding the other strand of said shRNA; and a 3-prime AAV-ITR.

16. The method of claim 12, wherein the composition is administered intra-arterially.

17. The method of claim 12, wherein the liposome comprises an exterior surface defining a sphere having a diameter of at most 200 nanometers.

18. The method of claim 12, wherein the liposome comprises one or more blood-brain barrier and brain cell membrane targeting agents and wherein at least 5 and at most 1000 blood-brain barrier or brain cell membrane targeting agents are conjugated to an exterior surface of the liposome.

19. The method of claim 18, wherein at least 25 and at most 40 blood-brain barrier or brain cell membrane targeting agents are conjugated to the surface of the liposome.

20. The method of claim 12, wherein the exterior surface of the liposome further comprises one or more conjugation agents selected from the group consisting of polyethylene glycol, sphingomyelin, biotin, streptavidin, organic polymers, and combinations thereof.

21. The method of claim 20, wherein the molecular weight of the conjugation agent is at least 1000 Daltons and at most 50,000 Daltons.

22. The method of claim 12, wherein the artificial AAV vector has been thermally treated in at least one heating and cooling cycle.

23. A medical system for delivering a small interfering RNA into a pre-determined location in a brain of a patient comprising: an intracranial access device selected from the group consisting of an intracranial catheter and an intracranial access port; a deliverable amount of a siRNA or a shRNA or a vector encoding said siRNA or said shRNA wherein said siRNA or said shRNA comprises a double-stranded portion between 21 and 30 nucleotides long, wherein one strand comprises 21 contiguous nucleotides encoded by SEQ ID NO: 26, 30, or 28; and a delivery means for delivering said small interfering RNA or vector encoding said small interfering RNA to said location of the brain from said intracranial access device.

24. The medical system of claim 23, wherein said delivery means is selected from the group consisting of an infusion pump, an electromechanical pump, and an osmotic pump.

25. The medical system of claim 23, wherein the predetermined location is the nucleus basalis of Meynert or the cerebral cortex or the hippocampus.

26. The medical system of claim 23, wherein the delivery means is injection from an external syringe into an intracranial access port.